腰椎间盘突出症经椎间孔镜治疗和椎板间开窗治疗的疗效观察

发布时间：2018-10-12 06:43

【摘要】：目的:回顾性评价经皮椎间孔镜椎间盘切除术(PTED)和传统椎板间扩大开窗术两种手术方式治疗腰椎间盘突出症的短期临床疗效,分析比较PTED和传统手术方式的优势与不足,为腰椎间盘突出症的治疗提供一定的临床参考及理论依据。方法:统计自2014年1月~2014年12月在山东中医药大学附属医院脊柱骨科病房住院的腰椎间盘突出症患者,并且分析其中的44例符合诊断标准及临床研究纳入标准并按时随访患者的临床及影像学资料。按手术方式分为两组,其中PTED组22例,开窗组22例。分别记录两组患者术前、术中及术后资料,包括手术时间、术中出血量、椎间盘切除量、术后绝对卧床时间、住院时间以及术前、术后1月、术后3月JOA评分、VAS评分、ODI评分,对以上所得结果进行统计学分析,并采用改良Macnab标准疗效评定两组术后3个月的临床疗效。结果:两组患者均随访3个月以上,对2种手术疗效进行比较。PTED组患者临床疗效优良率为90.91%,开窗组优良率为81.81%,在优良率比较上PTED组优于开窗组;比较两组的椎间盘切除量、术中出血量、术后绝对卧床时间等差异具有统计学意义,两组术后1月、3月JOA、VAS及ODI评分与术前相比,其差异有显著统计学意义,但两组组间评分差异无统计学意义。结论:PTED是传统手术的微创化,具有传统术式与经皮穿刺技术的优势,能直接到达椎间盘突出位置,摘除病变髓核,解除其对脊髓及神经根的压迫,在减少手术创伤的同时,达到与传统术式相似疗效,可作为单纯腰椎间盘突出症的有效治疗方式。
[Abstract]:Objective: to evaluate the short-term clinical effect of percutaneous foraminal discectomy (PTED) and traditional interlaminar fenestration in the treatment of lumbar disc herniation. To provide a certain clinical reference and theoretical basis for the treatment of lumbar disc herniation. Methods: from January 2014 to December 2014, the patients with lumbar disc herniation in the spine orthopedic ward of the affiliated Hospital of Shandong University of traditional Chinese Medicine were analyzed. The clinical and imaging data of 44 patients who met the diagnostic criteria and clinical study inclusion criteria and were followed up on time were analyzed. There were 22 cases in PTED group and 22 cases in fenestration group. Preoperative, intraoperative and postoperative data were recorded, including operative time, intraoperative blood loss, discectomy volume, absolute bed-rest time after operation, hospitalization time, JOA score, VAS score and ODI score before and after 1 month and 3 months after operation. The results were statistically analyzed, and the modified Macnab criteria were used to evaluate the clinical efficacy of the two groups 3 months after operation. Results: the two groups were followed up for more than 3 months. The excellent and good rates of the two groups were 90.91 in the PTED group and 81.81 in the fenestration group. The PTED group was better than the fenestration group in the excellent and good rate, and the discectomy amount in the two groups was compared. There were significant differences in blood loss during operation and absolute bed-rest time between the two groups. The scores of JOA,VAS and ODI were significantly different from those before operation at 1 month and 3 months after operation, but there was no significant difference between the two groups. Conclusion: PTED is a minimally invasive operation with the advantages of traditional operation and percutaneous puncture. It can directly reach the position of disc herniation, remove the diseased nucleus pulposus, relieve the compression of spinal cord and nerve root, and reduce the surgical trauma at the same time. It can be used as an effective treatment for simple lumbar disc herniation.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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