经皮椎间孔镜与椎板开窗术治疗腰椎间盘突出症的近期疗效对比

发布时间：2018-05-25 10:24

本文选题：椎间孔镜 + 椎板开窗　；参考：《广州中医药大学》2015年硕士论文

【摘要】：目的：本课题通过椎间孔镜下髓核摘除术与椎板间开窗髓核摘除术治疗腰椎间盘突出症,进行回顾性对比研究,以评价两种不同术式治疗腰椎间盘突出症的临床疗效及优缺点,并探讨椎间孔镜下髓核摘除术与椎板间开窗髓核摘除术治疗腰椎间盘突出症的有效性、安全性和作用机理,以期找到更优的手术治疗腰椎间盘突出症方法及临床应用价值。方法：通过对经皮椎间孔镜下髓核摘除术与椎板开窗髓核摘除术治疗腰椎间盘突出症的手术时间、手术切口、出血量、术前及术后JOA评分、VAS评分、ODI功能指数、改良MacNab标准等数据进行对比研究,根据研究成果得出两种不同术式对患者术后近期疗效的差异是否具有统计学意义,最后可探讨经皮椎间孔髓核摘除术与椎板开窗髓核摘除术在治疗腰椎间盘突出症的术后功能康复情况的区别,客观评价患者术后获益,可望为腰椎间盘突出症患者选择获益更大的手术提供新的思路和一定的参考价值。结果：1.组内基本资料对比：经单因素方差分析,两组间患者年龄及病程分布无显著性差异(P0.05),提示两组患者的年龄及病程构成比无差别。两组间性别构成比较无显著性差异(P0.05),提示两组患者的性别构成比无差别。2.组间手术前后出血量、手术时间对比：手术时间、术中出血量组间对比差异有统计学意义(P0.05),提示经皮椎间孔镜组在手术时间及术中出血量方面优于椎板开窗组。3.组内手术前后疗效评分对比：组内比较显示,两组在手术前、手术后进行评分,根据腰椎JOA、VAS、ODI及改良Macnab标准,两组手术后症状及功能均有改善((P0.05)),差异有显著性,说明术后患者症状有明显好转。结论：1.椎间孔镜及椎板开窗两种手术在治疗腰椎间盘突出症方面均能有效改善患者临床症状,提高患者的生活质量及减轻功能障碍。2.手术前后对比发现,椎间孔镜下摘除髓核治疗腰椎间盘突出症和功能改善更明显,优于对椎板开窗髓核摘除术的疗效,但远期疗效本课题未纳入研究范围。3.椎间孔镜下髓核摘除术与椎板开窗髓核摘除术治疗腰椎间盘突出症是一种疗效较迅速、确切,操作相对简单、安全可靠及副作用少的治疗方法。
[Abstract]:Objective: to evaluate the clinical efficacy, advantages and disadvantages of two different surgical methods in the treatment of lumbar disc herniation by intervertebral foramen endoscopy and interlaminar fenestration of nucleus pulposus in the treatment of lumbar disc herniation. The efficacy, safety and mechanism of intervertebral foramen endoscopy and interlaminar fenestration in the treatment of lumbar disc herniation were discussed in order to find a better operative method and clinical application value for the treatment of lumbar disc herniation. Methods: the operative time, incision, bleeding volume, JOA score and ODI index of lumbar disc herniation were evaluated by percutaneous transurethral foramen endoscopy and laminectomy for lumbar disc herniation. According to the data of modified MacNab standard and other data, we can find out whether there is statistical significance between the two kinds of operation methods in the short term after operation. Finally, the difference of functional rehabilitation between percutaneous intervertebral foraminal nucleus excision and laminectomy in the treatment of lumbar disc herniation was discussed. It is expected to provide new ideas and certain reference value for patients with lumbar disc herniation. The result is 1: 1. Comparison of basic data in the group: there was no significant difference in age and course of disease distribution between the two groups by univariate ANOVA, indicating that there was no difference in age and disease course ratio between the two groups. There was no significant difference in sex composition between the two groups (P 0.05), indicating that there was no difference in sex composition ratio between the two groups. There were significant differences in blood loss and operative time between groups before and after operation (P 0.05), suggesting that the time of operation and the amount of intraoperative bleeding in percutaneous foraminal surgery group were better than that in laminectomy group. Comparison of curative effect scores before and after operation in two groups: before and after operation, according to JOAA VASO ODI and modified Macnab standard, the symptoms and functions of the two groups were improved after operation (P 0.05), and the difference was significant. It showed that the symptoms of the patients were obviously improved after operation. Conclusion 1. Intervertebral foramen and lamina fenestration can effectively improve the clinical symptoms of patients with lumbar disc herniation, improve the quality of life of patients and alleviate dysfunction. 2. The results before and after operation showed that the removal of nucleus pulposus under intervertebral foramen was more obvious in the treatment of lumbar disc herniation and the improvement of function, which was better than that in the removal of nucleus pulposus with fenestration of vertebral lamina, but the long-term effect was not included in the scope of study. 3. The treatment of lumbar disc herniation with intervertebral foraminal discectomy and laminectomy is a rapid, accurate, relatively simple, safe and reliable treatment method with less side effects.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

【相似文献】