PTED与MED治疗腰椎间盘突出症的近期疗效比较

发布时间：2019-01-09 14:07

【摘要】：目的：通过比较经皮椎间孔镜下椎间盘切除术(PTED)与显微内镜下椎间盘切除术(MED)治疗腰椎间盘突出症的近期疗效,探讨各自的最佳适应症。方法：1、回顾性分析自2013年7月至2014年2月,我科收治的腰椎间盘突出症患者,从符合病例选择标准的患者中随机选择90例,根据手术方式分为显微内镜下椎间盘切除术治疗组(MED组)和经皮椎间孔镜下椎间盘切除术(PTED组)。其中MED组45例,男26例,女性19例;PTED组45例,男27例,女18例。2、通过回顾比较两组患者手术切口长度、手术出血量、手术时间、术中透视次数、术后卧床时间、术后住院时间以及患者术前、术后3天、术后3月、术后6月的VAS评分和ODI评分,对两组患者进行疗效分析。结果：1、PTED组平均手术切口长度6.9mm,手术出血量12.4ml,手术时间85.6min,术中透视次数24.6次,术后卧床6.1h,术后住院2.8 d; MED组平均手术切口长度17.9mm,手术出血量39.8m1,手术时间49.6min,术中透视次数2.5次,术后卧床80.6h,·术后住院6.3d。2、在手术切口长度、手术出血量、术后卧床时间和术后住院时间的比较上,PTED组优于MED组,差异具有统计学意义(P0.05); MED组较PTED组术中透视次数更少、手术时间更短,差异具有统计学意义(P0.05)。3、PTED组和MED组术后、JAS、ODI评分与术前比较,均明显改善(P0.05)；术后短期内腰痛VAS评分PTED组低于MED组,PTED组腰痛手术改善率优于MED组,差异具有统计学意义(P0.05)；两组术后3月、6月腰痛VAS评分相比,两组术后和随访腿痛VAS评分、ODI评分相比,两组腿痛VAS评分、ODI评分手术改善率相比,差异无统计学意义(P0.05)。结论：PTED和MED两种微创手术方式均是腰椎间盘突出症的有效治疗方式。PTED较MED具有手术创伤更小,出血量更少,术后恢复更快等优点。与PTED相比,MED具有透视射线损伤更小,手术时间更短等优点。
[Abstract]:Objective: to compare the short term efficacy of percutaneous foraminal discectomy (PTED) and microendoscopic discectomy (MED) in the treatment of lumbar disc herniation. Methods: 1. From July 2013 to February 2014, 90 patients with lumbar disc herniation were randomly selected from patients who met the criteria of case selection. According to the operation mode, the patients were divided into microendoscopic discectomy group (MED group) and percutaneous foraminal discectomy group (PTED group). There were 45 cases in MED group, 26 cases in male and 19 cases in female. In PTED group, there were 45 cases (27 males and 18 females). 2. The length of incision, the amount of bleeding, the time of operation, the times of fluoroscopy, the time of bed rest, the time of hospitalization and the 3 days after operation were retrospectively compared between the two groups. VAS score and ODI score were analyzed 3 months after operation and 6 months after operation. Results: 1in the PTED group, the average incision length was 6.9 mm, the operative bleeding was 12.4 ml, the operation time was 85.6 min, the times of fluoroscopy were 24.6 times, the postoperative bed was kept in bed for 6.1 hours, and the postoperative hospital stay was 2.8 days. In the MED group, the average incision length was 17.9 mm, the operative bleeding was 39.8 ml, the operative time was 49.6 min, the times of fluoroscopy was 2.5 times, the postoperative bed was in bed for 80.6 hours, the hospital stay was 6.3 d.2. the length of the incision and the amount of operative bleeding were found in the MED group. PTED group was better than MED group in postoperative bed rest time and postoperative hospitalization time, the difference was statistically significant (P0.05). Compared with PTED group, MED group had fewer times of intraoperative fluoroscopy and shorter operation time, the difference was statistically significant (P0.05). 3The JAS,ODI score of MED group and MED group were significantly improved compared with pre-operation group (P0.05). The VAS score of PTED group was lower than that of MED group, and the improvement rate of PTED group was better than that of MED group. The difference was statistically significant (P0.05). There was no significant difference between the two groups in VAS score of low back pain, VAS score of leg pain, ODI score, VAS score of leg pain and ODI score in two groups (P0.05). Conclusion: both PTED and MED are effective methods for the treatment of lumbar disc herniation, PTED has the advantages of less trauma, less bleeding and faster postoperative recovery than MED. Compared with PTED, MED has the advantages of less X-ray injury and shorter operation time.
【学位授予单位】：东南大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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