显微内窥镜下髓核摘除纤维环缝合治疗腰椎间盘突出症的疗效分析

发布时间：2018-06-05 14:57

本文选题：腰椎间盘突出症 + 显微内窥镜下椎间盘髓核摘除术　；参考：《中国脊柱脊髓杂志》2017年03期

【摘要】：目的 :评价显微内窥镜下腰椎间盘髓核摘除联合纤维环缝合治疗腰椎间盘突出症(LDH)的安全性、临床疗效以及术后复发率。方法:回顾性分析我院2012年3月~2014年3月接受显微内窥镜下腰椎间盘髓核摘除术(MED)治疗的290例单节段LDH患者,男160例,女130例,年龄20~66岁(38.1±12.1岁)。其中172例单纯行MED(对照组),118例行MED联合纤维环缝合术(缝合组)。两组患者的年龄、性别比、体重指数、手术节段、突出类型及随访时间无法无统计学差异(P0.05),记录两组患者手术时间、出血量、术前及随访时疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)。利用影像学资料测量术前及随访时手术节段椎间隙高度。结果:两组患者平均手术时间和平均手术出血量比较均无统计学差异(P0.05)。随访24~32个月(28.35±5.08个月),两组组内ODI评分、腰痛VAS评分、下肢痛VAS评分术前与术后3个月、末次随访时比较均有统计学差异(P0.05),同时间点两组间比较无统计学差异(P0.05)。对照组末次随访时椎间隙高度(8.29±1.43mm)较术前(10.34±1.74mm)降低19.83%,缝合组末次随访椎间隙高度(8.94±1.35mm)较术前(10.46±1.55mm)降低14.53%,两组组间比较无统计学差异(P0.05)。对照组术后同节段复发14例,复发率为8.14%,再手术患者6例,再手术率3.49%;缝合组术后3例患者复发,复发率为2.54%,再手术患者1例,再手术率为0.85%。两组复发率和再手术率比较有统计学差异(P0.05)。结论:显微内窥镜下椎间盘髓核摘除纤维环缝合术治疗LDH操作简便、安全可行,可获得满意的临床疗效;在严格把握适应证的条件下,可有效降低术后复发率及再手术率。
[Abstract]:Objective: to evaluate the safety, clinical effect and recurrence rate of microendoscopic lumbar disc nucleus pulpotomy combined with fiber ring suture in the treatment of lumbar disc herniation. Methods: from March 2012 to March 2014, 290 patients (160 males and 130 females) with single segment LDH treated by microendoscopic discectomy of nucleus pulposus were retrospectively analyzed. Their age was 20 ~ 66 years old and 38.1 卤12.1 years old. Among them 172 cases were treated with MED alone (control group 118 cases) with MED combined with annular suture (suture group). There was no significant difference in age, sex ratio, body mass index, operative segment, protrusion type and follow-up time between the two groups (P 0.05). Preoperative and follow-up visual analogue scale (VAS) was used to evaluate Oswestry dysfunction index (Oswestry index). The height of the segmental intervertebral space was measured by imaging data before operation and during follow-up. Results: there was no significant difference between the two groups in the mean operative time and the mean blood loss (P 0.05). The follow-up time ranged from 24 to 32 months (28.35 卤5.08 months). There were significant differences in ODI score, VAS score for low back pain and VAS score for lower extremity pain between the two groups before and after the last follow-up (P 0.05). There was no significant difference between the two groups at the same time point (P 0.05). In the control group, the height of intervertebral space was decreased by 8.29 卤1.43mm at the last follow-up and 19.83mm by 10.34 卤1.74mm. The height of intervertebral space was decreased by 8.94 卤1.35mm at the last follow-up in the suture group. The height of intervertebral space was decreased by 14.53mm compared with that of the control group (10.46 卤1.55mm). There was no significant difference between the two groups (P 0.05). In the control group, 14 cases had recurrence in the same segment, the recurrence rate was 8.14, and the reoperation rate was 3.49 in 6 patients with reoperation, while in the suture group, the recurrence rate was 2.54 and the reoperation rate was 0.85. There was significant difference in recurrence rate and reoperation rate between the two groups (P 0.05). Conclusion: microendoscopic discectomy and annular suture of intervertebral disc is simple, safe and feasible in the treatment of LDH, and it can effectively reduce the recurrence rate and reoperation rate under the condition of strict indication.
【作者单位】：南方医科大学第三附属医院脊柱外科;
【基金】：广东省科技计划项目(编号:412018908043)
【分类号】：R687.3

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