可扩张脊柱微创通道下腰椎间盘突出症髓核摘除后纤维环裂口的缝合修复

发布时间：2019-06-07 19:43

【摘要】：背景:研究表明,腰椎间盘突出髓核摘除后行纤维环缝合可在获得良好疗效的同时降低复发率,但有效的修复方法及可靠的修复器械报道极少。目的:观察在可扩张脊柱微创通道下腰椎间盘突出症髓核摘除后进行纤维环裂口缝合修复的临床效果。方法:纳入2013年8月至2015年8月湖北省中医院收治的腰椎间盘突出症患者50例,随机分为2组,缝合组25例在髓核摘除后行纤维环缝合术,对照组25例单纯行髓核摘除术。记录并比较2组切口长度、手术时间、术中失血量,评估治疗前后Oswestry功能障碍评分(ODI)、腰痛及下肢痛的目测类比评分,同时观察手术并发症及复发情况。结果与结论:(1)缝合组25例患者获得完整随访,对照组只有23例完成随访;(2)2组患者性别、年龄及手术节段等相比差异无显著性意义(P0.05);(3)2组目测类比评分及ODI术后各时间点与术前比较均明显降低(P0.05)。2组间比较,除术后1个月的目测类比评分外,缝合组与对照组术前及术后ODI、目测类比评分比较差异均无显著性意义(P0.05);(4)对照组2例复发,其中1例行再手术治疗,复发率9%;缝合组中1例复发,并未再次手术,复发率4%;(5)2组均未发生脑脊液漏、感染、神经根损伤等严重并发症;(6)综上,腰椎间盘摘除后同时行纤维环裂口缝合术创伤小,重建了椎间盘的完整结构,可有效防止髓核再突出,具有可行性与有效性,临床疗效满意。
[Abstract]:Background: studies have shown that fiber ring suture after nucleus pulposus extirpation can achieve good curative effect and reduce recurrence rate, but there are few reports of effective repair methods and reliable repair instruments. Objective: to observe the clinical effect of suture repair of annulus fibrosus after nucleus pulposus extirpation of lumbar disc protrusion under expandable spinal minimally invasive channel. Methods: from August 2013 to August 2015, 50 patients with lumbar disc protrusion were randomly divided into two groups. 25 patients in suture group underwent annulectomy after nucleus pulposus extirpation, and 25 patients in control group underwent nucleus pulposus extraction alone. The length of incision, operation time and blood loss during operation were recorded and compared. The visual analogy score of Oswestry dysfunction score (ODI), low back pain and lower extremity pain before and after treatment was evaluated, and the complications and recurrence of the operation were observed at the same time. Results and conclusion: (1) 25 patients in the suture group were followed up completely, while only 23 patients in the control group were followed up. (2) there was no significant difference in sex, age and surgical segment between the two groups (P 0.05). (3) the visual analogy score of the two groups was significantly lower than that of the control group at each time point after ODI (P 0.05). Except for the visual analogy score of 1 month after operation, the ODI, of the suture group and the control group were significantly lower than those of the control group before and after operation (P 0.05). There was no significant difference in visual analogy score (P 0.05). (4) in the control group, there were 2 cases of recurrence, of which 1 case was treated with reoperation, the recurrence rate was 9%, 1 case in the suture group was recurrent, and the recurrence rate was 4%. (5) there were no serious complications such as cerebrospinal fluid leakage, infection and nerve root injury in both groups. (6) in summary, the suture of annulus fibrosus after lumbar disc extirpation has little trauma, and the complete structure of intervertebral disc can be reconstructed, which can effectively prevent the reprotrusion of nucleus pulposus, which is feasible and effective, and the clinical effect is satisfactory.
【作者单位】：湖北省中医院骨伤科;
【基金】：湖北省中医院科研课题资助项目(JDZX2014Q06)~~
【分类号】：R687.3

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