椎间盘镜结合纤维环缝合与椎间孔镜治疗单节段腰椎间盘突出症的临床对照研究

发布时间：2018-05-08 17:10

本文选题：纤维环缝合 + 椎间孔镜下腰椎髓核摘除术　；参考：《宁波大学》2017年硕士论文

【摘要】：目的比较椎间盘镜下腰椎纤维环缝合术(micro endoscopic discectomy with annulus repair)与椎间孔镜下腰椎髓核摘除术(percutaneous endoscopic lumbar discectomy)两种手术方式应用于单节段腰椎间盘突出症的治疗的临床疗效。方法采用回顾性研究方法,选取我科2015年1月—2016年1月收治单节段单侧腰椎间盘突出症的患者80例,行“椎间盘镜下纤维环缝合术”和行“椎间孔镜下髓核摘除术”患者各40例,分为纤维环缝合组和椎间孔镜组。通过分析院内治疗情况、腰背痛视觉模拟量表评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)、改良的Macnab评价标准等数据来评估椎间盘镜下腰椎纤维环缝合术与椎间孔镜下腰椎髓核摘除术的临床疗效。结果两组患者手术过程及术后随访均顺利完成,手术后随访12-22个月,平均16个月。纤维环缝合组平均手术切口(18.27±1.20)mm、手术出血量(54.75±9.47)ml、手术时间(73.25±7.89)min、术后住院时间(7.38±0.95)d。椎间孔镜组平均手术切口(7.30±0.79)mm、手术出血量(6.85±1.23)ml、手术时间(59.13±8.61)min、术后住院时间(6.10±0.74)d。两组患者各自手术前的后VAS、ODI进行比较,均有明显改善。两组患者术后1年内随访VAS、ODI、改良的Macnab标准组间相比较,差异无统计学意义。纤维环缝合组患者顺利进行手术40例,其中纤维环缝合成功33例,缝合成功率82.5%,复发1例,对症治疗后好转,未再次手术;椎间孔镜组患者顺利进行手术40例,复发5例,4例患者进行再次手术治疗后好转,1例对症治疗后好转,未再次手术。结论椎间盘镜下腰椎纤维环缝合术在单节段腰椎间盘突出症患者治疗经过中与椎间孔镜下腰椎髓核摘除术相比,在手术切口、手术出血量、手术时间、术后住院时间方面稍差,但其修复了破裂的纤维环,对于降低患者再次的手术几率有一定的优势,但纤维环缝合有一定缝合失败率,需进一步研究与改进。
[Abstract]:Objective to compare the clinical efficacy of micro endoscopic discectomy with annulus repair) and percutaneous endoscopic lumbar discectomy) in the treatment of single segment lumbar disc herniation. Methods A retrospective study was conducted in 80 patients with unilateral lumbar disc herniation from January 2015 to January 2016. The patients were divided into fiberoptic annular suture group and intervertebral foramen endoscope group. By analyzing the treatment situation in the hospital, The visual analogue scale for low back pain (VAS) was used to evaluate the clinical efficacy of lumbar disc annular suture and intervertebral foramen endoscopy for lumbar spinal nucleus extirpation. The index of Oswestry disability index (Oswestry disability index) and the modified Macnab evaluation criteria were used to evaluate the clinical effect of lumbar spinal cord annular suture and intervertebral foraminal lumbar nucleus extirpation. Results the operation process and postoperative follow-up of the two groups were successfully completed, 12 to 22 months after operation, an average of 16 months. In the fibrous ring suture group, the average incision was 18.27 卤1.20mm, the blood loss was 54.75 卤9.47ml, the operative time was 73.25 卤7.89 min, and the postoperative hospitalization time was 7.38 卤0.95d. In the intervertebral foramen group, the average incision was 7.30 卤0.79 mm, the volume of operative bleeding was 6.85 卤1.23 ml, the operative time was 59.13 卤8.61 min, and the postoperative hospitalization time was 6.10 卤0.74 days. There was significant improvement in VASO ODI between the two groups before and after operation. VAS-ODI was followed up 1 year after operation in both groups. There was no significant difference between the modified Macnab standard groups. The successful rate of suture was 82.5%, and the recurrence rate was 1 case. The patients in the intervertebral foramen group underwent successful operation in 40 cases. There were 5 cases of recurrence and 4 cases of recurrence. After reoperation, 1 case got better after symptomatic treatment, but no reoperation. Conclusion the treatment of lumbar disc herniation by endoscopy with lumbar annular suture is worse than that of intervertebral foramen endoscopy in the surgical incision, the amount of bleeding, the time of operation and the length of hospital stay after operation. However, the repair of the ruptured fiber ring has a certain advantage in reducing the probability of reoperation, but the suture failure rate is certain, which needs further study and improvement.
【学位授予单位】：宁波大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

【相似文献】