神经根阻滞联合椎间孔镜术治疗不典型腰椎间盘突出症

发布时间：2018-11-26 17:42

【摘要】：[目的]比较神经根阻滞联合经皮椎间孔镜技术与传统开放手术治疗不典型腰椎间盘突出症的临床疗效。[方法]回顾2012年6月~2014年8月在本院治疗的52例不典型腰椎间盘突出症患者,用随机数字表法分为微创组和传统组。其中微创组24例行经皮椎间孔镜术,传统组28例行椎板开窗减压术,记录分析围手术期参数及术中术后相关指标。分析术前术后访视记录的视觉疼痛模拟评分(VAS)、改良下腰痛日本骨科学会(JOA)评分、OSWESTRY功能障碍指数评定(ODI)并按改良Macnab标准评价术后疗效。[结果]两组术中出血量、切口长度、卧床时间、住院天数差异有统计学意义(P0.05),且微创组明显优于传统组,两组手术时间相比差异无统计学意义(P0.05)。两组术后VAS评分、JOA评分、ODI功能障碍指数组间比较差异无统计学意义(P0.05),但各组与术前相比差异均有统计学意义(P0.05)。两组按改良Macnab标准评定优良率分别为:91.67%(22/24)、89.29%(25/28),组间比较差异无统计学意义(P0.05)。两组并发症发生率分别为8.33%(2/24)和7.14%(2/28),两者差异无统计学意义(P0.05)。[结论]不典型腰椎间盘突出症临床上容易误诊,神经根阻滞可以有效进行定位定性诊断,神经根阻滞联合经皮椎间孔镜与传统开放手术治疗不典型腰椎间盘突出症能取得相似的效果,但前者具有创伤小、出血少、术后恢复快、疗效确切等优点。
[Abstract]:[objective] to compare the clinical effects of nerve root block combined with percutaneous foramen surgery and traditional open surgery in the treatment of atypical lumbar disc herniation. [methods] 52 patients with atypical lumbar disc herniation treated in our hospital from June 2012 to August 2014 were reviewed and randomly divided into two groups: minimally invasive group and traditional group. In the minimally invasive group, 24 cases were treated with percutaneous foramen surgery, and 28 cases in the traditional group were treated with laminectomy and decompression. The perioperative parameters were recorded and analyzed. Analogue score of visual pain recorded before and after operation (VAS), modified (JOA) score of Japanese Orthopedic Society for low back pain and OSWESTRY dysfunction Index were used to evaluate (ODI) and evaluate the postoperative efficacy according to the modified Macnab standard. [results] there were significant differences in intraoperative bleeding volume, incision length, bed rest time and hospitalization days between the two groups (P0.05), and the minimally invasive group was significantly better than the traditional group, and there was no significant difference in the operation time between the two groups (P0.05). There was no significant difference in VAS score, JOA score and ODI dysfunction index between the two groups (P0.05), but there was significant difference between the two groups (P0.05). The excellent and good rates of the two groups were 91.67% (22 / 24) and 89.29% (25 / 28) according to the modified Macnab standard, respectively. There was no significant difference between the two groups (P0.05). The incidence of complications in the two groups was 8.33% (2 / 24) and 7.14% (2 / 28) respectively. There was no significant difference between the two groups (P0.05). [conclusion] atypical lumbar disc herniation is easy to be misdiagnosed clinically, and nerve root block can be used for localizing and qualitative diagnosis. Nerve root block combined with percutaneous foramen surgery can achieve similar results in the treatment of atypical lumbar disc herniation, but the former has the advantages of less trauma, less bleeding, quick postoperative recovery and accurate curative effect.
【作者单位】：南昌大学第二附属医院骨科江西省骨科研究所;
【分类号】：R687.3

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