经皮椎间孔镜手术治疗腰椎间盘突出症的近期疗效观察

发布时间：2018-05-13 04:10

本文选题：腰椎间盘突出症 + 椎间孔镜　；参考：《长春中医药大学》2016年硕士论文

【摘要】：目的:通过对经皮椎间孔镜椎间盘切除术(PTED)与可动式显微内镜下椎间盘切除术(MMED)两种手术方式治疗腰椎间盘突出症的近期疗效指标与卫生经济学指标进行对比,探讨PTED术式的利弊,分析PTED方法治疗腰椎间盘突出症的关键因素和经济价值,为PTED微创术式的普及和推广提供有益参考。方法:采用回顾分析的方法,观察手术患者共79例,其中PTED组48例,MMED开窗组31例,记录两组一般资料如性别、年龄等,于术前、术后48h、术后2月随访行腰痛、腿痛VAS评分及Oswestry功能障碍指数(ODI),按照中华骨科学会脊柱学组腰背痛手术评分标准评价两组的临床疗效,并统计住院天数、术后至出院天数、抗菌药费用、住院总费用、手术费用等卫生经济学指标。结果:PTED组患者手术前后对比发现,术后48h、2月腰痛、腿痛VAS评分及ODI较术前均有明显改善(P0.05)。同时对两组患者术后对比发现,PTED组术后48h腰痛VAS得分、术后2月腰痛VAS得分、术后2月ODI均低于MMED开窗组(P0.05);而术后48h腿痛VAS得分、术后2月腿痛VAS得分、术后48h ODI两组之间无显著差异(P0.05)。PTED组住院天数、术后至出院天数、抗菌药费用均少于开窗组(P0.05);而PTED组住院总费用、手术费用均高于开窗组(P0.05)。结论:PTED微创手术是治疗腰椎间盘突出症的有效可靠术式。具有临床疗效好、创伤小、直达突出部位、解除椎管内压迫迅速、减少住院天数及抗菌药使用等优势,在严格掌控手术适应症的情况下,优于可动式显微内镜下椎间盘切除术。
[Abstract]:Objective: to compare the short-term curative effect of PTED and MMED in the treatment of lumbar disc herniation by percutaneous foraminal discectomy (PTED) and microendoscopic discectomy (MMED). To discuss the advantages and disadvantages of PTED operation, to analyze the key factors and economic value of PTED in the treatment of lumbar disc herniation, and to provide a useful reference for the popularization and popularization of PTED minimally invasive operation. Methods: a retrospective analysis was performed on 79 patients, including 48 cases in PTED group and 31 cases in MMED window opening group. The general data of the two groups were recorded, such as sex, age, etc. The patients were followed up for 2 months before operation, 48 hours after operation, and 2 months after operation. The VAS score of leg pain and the index of Oswestry dysfunction were used to evaluate the clinical efficacy of the two groups according to the standard of surgical score for low back pain in the spine group of the Chinese Orthopaedic Society, and to count the days of hospitalization, the days from postoperative to discharge, the cost of antimicrobial agents, and the total cost of hospitalization. Cost of surgery and other health economic indicators. Results the VAS score and ODI of patients with low back pain and leg pain were significantly improved at 48 hours, 2 months after operation and before and after operation. At the same time, the patients in the two groups were found to have low back pain (VAS) scores at 48 hours after operation, VAS scores at 2 months after operation, and lower ODI scores than those in MMED window opening group at 2 months after operation, while VAS scores in leg pain group and VAS score in leg pain group at 48 hours after operation, and VAS scores in leg pain at 2 months after operation. There was no significant difference between the two groups at 48h after operation, and the cost of antibiotics was lower than that of the windowing group (P 0.05), while the total hospitalization cost of PTED group was higher than that of window opening group (P 0.05), while that of PTED group was higher than that of fenestration group (P 0.05), and the cost of antimicrobial agents in PTED group was higher than that in window opening group (P 0.05). Conclusion the small-invasive operation with small-wound PTED is an effective and reliable procedure for the treatment of lumbar disc herniation. It has the advantages of good clinical effect, little trauma, direct protrusion, rapid release of compression in the spinal canal, reduction of hospital stay and use of antimicrobial drugs, and is superior to removable microendoscopic discectomy under the condition of strictly controlling the indication of operation.
【学位授予单位】：长春中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R687.3

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