经皮内镜腰神经根减压术后疼痛改善的研究

发布时间：2018-04-29 21:12

本文选题：下腰痛 + 神经根性病变　；参考：《中国人民解放军医学院》2017年硕士论文

【摘要】：目的:观察并评估经皮内镜腰神经根减压术治疗腰腿疼痛术后的疼痛改善情况。方法:对解放军总医院骨科2015年1月-2016年1月连续84例经皮脊柱内镜腰神经减压术治疗腰背痛和(或)神经根性下肢痛的患者,前瞻随访两种疼痛各自在术前、术后1-12周(1周1次)的VAS评分及末次随访时的改良MacNab疗效评定,评估两种疼痛各自在术后12周里的改善情况,比较两者的疼痛改善度(术前VAS-末次随访VAS)和末次随访时的改良MacNab疗效评定,用末次随访时ODI、腰背痛VAS、下肢痛VAS评分与术前比较评价全体患者的手术疗效。结果:腰背痛术后1-12周VAS评分相邻两周间差异无统计学意义(P均0.05);下肢痛术后 VAS 评分第 2 周 vs 第 1 周[(2.96±1.97)分 vs(2.10±1.29)分、P0.05]、差异显著,第 4 周 vs 第 3 周[(2.04±1.62)分 vs (2.46±1.97)分、P0.05]、差异显著,余下相邻两周间差异无统计学意义(P0.05);下肢痛术后12周VAS改善度及改良MacNab优良率均显著优于腰背痛[(6.64±1.47)分vs (3.36±1.38)分、86%vs73%,P0.05];全体患者末次随访ODI、腰背痛VAS、下肢痛VAS均较术前显著降低[(12.82±6.39)分 vs (53.64±11.73)分、(1.16±1.06)分 vs (4.52±0.65)分、(1.29±1.30)分 vs (7.93±0.81)分,P 均0.05]。结论:经皮内镜腰神经根减压术后12周患者腰背痛的改善平稳,而下肢痛的改善在术后第2周、3周出现波动,术前应指导患者建立对手术效果和术后恢复的合理预期,术后应观察至少3周、其后是否有下降趋势,可在术后第2、3周通过物理治疗、药物治疗等进行对症处理。经皮内镜腰神经根减压术适合治疗以单侧下肢根性疼痛为突出表现的腰椎退变疾病,轴性腰痛并非其最佳适应症。
[Abstract]:Objective: to observe and evaluate the improvement of pain after percutaneous endoscopic lumbar nerve root decompression for lumbar and leg pain. Methods: from January 2015 to January 2016, 84 consecutive patients with low back pain and / or nerve root pain were treated by percutaneous endoscopic lumbar nerve decompression. VAS score at 1-12 weeks after operation and modified MacNab evaluation at the last follow-up were used to evaluate the improvement of the two kinds of pain in 12 weeks postoperatively. The degree of pain improvement (preoperative VAS-last follow-up vs) and modified MacNab evaluation at the last follow-up were compared between the two groups. The surgical efficacy of all patients was evaluated with VAS score of LBP, LBP and VAS-LBP at the last follow-up. Results: there was no significant difference in the VAS score between the two weeks after the operation of low back pain (P < 0.05), and the VAS score in the second week after operation was significantly higher than that in the first week (P < 0.05) [2.96 卤1.97) vs(2.10 卤1.29 (P0.05)]. The fourth week vs the third week [2.04 卤1.62) vs 2.46 卤1.97], the difference was significant. There was no significant difference between the remaining two weeks (P 0.05), the improvement degree of VAS and the excellent and good rate of modified MacNab 12 weeks after operation were significantly better than those of low back pain [6.64 卤1.47) vs 3.36 卤1.38]. The score was decreased [12.82 卤6.39) vs 53.64 卤11.73) (1.16 卤1.06) vs 4.52 卤0.65) (1.29 卤1.30) vs 7.93 卤0.81 (P 0.05). Conclusion: the improvement of low back pain is stable at 12 weeks after percutaneous endoscopic lumbar nerve root decompression, while the improvement of lower extremity pain fluctuates at the second week after operation. It should be observed at least 3 weeks after the operation, then whether there is a downward trend or not, can be treated by physical therapy, drug therapy and so on in the 2nd week after operation. Percutaneous endoscopic lumbar nerve root decompression is suitable for the treatment of lumbar degenerative diseases characterized by unilateral lower limb root pain. Axial low back pain is not the best indication.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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