经皮椎间孔镜与小切口椎板间开窗髓核切除术治疗腰椎间盘突出症的对比研究
发布时间：2019-06-15 07:21
【摘要】：目的观察经皮椎间孔镜椎间盘切除术(PTED)与小切口椎板开窗术治疗腰椎间盘突出症的手术指标、近期疗效和并发症发生情况,探讨经PTED在腰椎间盘突出症中的应用价值。方法选取2014年6月-2015年5月在我院就诊的腰椎间盘突出患者80例进行研究,患者被简单随机化法随机分为研究组和对照组各40例,对照组采用小切口椎板开窗术治疗,研究组采用PTED治疗。观察两组患者的手术时间、术中出血量、切口长度、并发症发生率等及3月时椎间隙降低情况。术前、术后1d、术后3月、术后6月观察两组患者的VAS评分;术前、术后6月评定患者的JOA评分;术前、术后3月、术后6月评定患者的ODI评分和Lehmann腰椎功能评分;术后6月采用改良MacNab标准进行疗效评价。结果1.手术相关指标研究组和对照组手术时间、切口长度、术中出血量、咬骨体积、卧床时间、住院时间等指标差异均有统计学意义(P0.01)。研究组住院总花费为高于对照组,但差异无统计学意义(P0.05)。2.VAS评分两组治疗后1d较治疗前VAS评分显著降低,差异有统计学意义(P0.01),术后1d、3月、6月间比较差异均无统计学意义(P0.05)。各时间点组间对比差异均无统计学意义(P0.05)。3.ODI指数研究组和对照组两组术后3月均明显低于术前,术后6月明显低于术前和术后3月,差异均有统计学意义(P0.01)。两组术前、术后3月和术后6月组间对比差异均无统计学意义(P0.05)。4.lehmann腰椎功能评分研究组和对照组两组术后1d、3月和6月的评分均高于术前,术后3月和6月评分高于术后1d,差异均有统计学意义(p0.01),术后3月和6月评分差异无统计学意义(p0.05)。术前、术1d、术后3月和术后6月组间lehmann腰椎功能评分差异均无统计学意义(p0.05)。5.joa评分研究组和对照组术后6月joa评分均高于治疗前,差异有统计学意义(p0.01)。术前、术后6月两组的joa评分差异均无统计学意义(p0.05)。6.改良macnab评分疗效对照组优良率为87.5%;研究组优良率为92.5%。两组优良率比较差异无统计学意义(p0.05),两组治疗效果比较差异无统计学意义(p0.05)。7.3个月椎间隙高度降低比较术后3个月对照组和研究组椎间隙高度降低分别为(8.04±1.69)%和(2.64±0.72)%,差异有显著统计学意义(p0.01)。8.并发症研究组和对照组的并发症发生率分别为12.5%和发生率为17.5%,两组并发症发生率差异无统计学意义(χ2=0.392,p=0.531)。结论经皮椎间孔tessys技术和小切口椎板间开窗治疗ldh均可取得良好的效果,经皮椎间孔tessys技术在微创方面更具优势,值得临床推广应用。
[Abstract]:Objective to observe the surgical indexes, short-term curative effect and complications of (PTED) and small incision lamina fenestration in the treatment of lumbar disc herniation, and to explore the value of PTED in the treatment of lumbar disc herniation. Methods from June 2014 to May 2015, 80 patients with lumbar disc protrusion were randomly divided into study group (n = 40) and control group (n = 40). The control group was treated with small incision lamina fenestration and the study group was treated with PTED. The operation time, intraoperative blood loss, incision length, incidence of complications and the decrease of intervertebral space at 3 months were observed. The VAS scores of the two groups were observed before, 1 day, 3 months and 6 months after operation, the JOA scores of the patients were evaluated before and 6 months after operation, the ODI scores and Lehmann lumbar function scores of the patients were evaluated before, 3 months and 6 months after operation, and the curative effect was evaluated by modified MacNab standard 6 months after operation. Result 1. There were significant differences in operation time, incision length, intraoperative blood loss, occlusal volume, bed rest time and hospitalization time between the study group and the control group (P 0.01). The total cost of hospitalization in the study group was higher than that in the control group, but the difference was not statistically significant (P 0.05). 2. The VAS score of the two groups was significantly lower than that before treatment on the 1st day after treatment, the difference was statistically significant (P 0.01), and there was no significant difference between 1 day, 3 months and 6 months after treatment (P 0.05). There was no significant difference between the two groups at each time point (P 0.05). 3. The ODI index in the study group and the control group was significantly lower than that before operation, and 6 months after operation was significantly lower than that before operation and 3 months after operation, the difference was statistically significant (P 0.01). There was no significant difference between the two groups before operation, 3 months after operation and 6 months after operation (P 0.05). 4. The scores of 3 months and 6 months after operation in the study group and the control group were higher than those before operation, and the scores at 3 months and 6 months after operation were significantly higher than those at 1 day after operation (p0.01), but there was no significant difference between 3 months and 6 months after operation (p0.05). There was no significant difference in lehmann lumbar function score between the groups before operation, 1 day after operation, 3 months after operation and 6 months after operation (p0.05). 5.joa score in the study group and the control group at 6 months after operation were significantly higher than those before treatment, the difference was statistically significant (p0.01). There was no significant difference in joa score between the two groups before and 6 months after operation (p0.05). 6. The excellent and good rate of the improved macnab score was 87.5% in the control group and 92.5% in the study group. There was no significant difference in the excellent and good rate between the two groups (p0.05), and there was no significant difference in the therapeutic effect between the two groups (p0.05). Compared with the control group and the study group at 3 months after operation, the height of intervertebral space decreased by (8.04 卤1.69)% and (2.64 卤0.72)%, respectively, with significant difference (p0.01). 8 months after operation, the height of intervertebral space in the control group and the study group was (8.04 卤1.69)% and (2.64 卤0.72)%, respectively. The incidence of complications in the study group and the control group was 12.5% and 17.5%, respectively. there was no significant difference in the incidence of complications between the two groups (蠂 2 = 0.392, p 鈮，
本文编号：2500061
[Abstract]:Objective to observe the surgical indexes, short-term curative effect and complications of (PTED) and small incision lamina fenestration in the treatment of lumbar disc herniation, and to explore the value of PTED in the treatment of lumbar disc herniation. Methods from June 2014 to May 2015, 80 patients with lumbar disc protrusion were randomly divided into study group (n = 40) and control group (n = 40). The control group was treated with small incision lamina fenestration and the study group was treated with PTED. The operation time, intraoperative blood loss, incision length, incidence of complications and the decrease of intervertebral space at 3 months were observed. The VAS scores of the two groups were observed before, 1 day, 3 months and 6 months after operation, the JOA scores of the patients were evaluated before and 6 months after operation, the ODI scores and Lehmann lumbar function scores of the patients were evaluated before, 3 months and 6 months after operation, and the curative effect was evaluated by modified MacNab standard 6 months after operation. Result 1. There were significant differences in operation time, incision length, intraoperative blood loss, occlusal volume, bed rest time and hospitalization time between the study group and the control group (P 0.01). The total cost of hospitalization in the study group was higher than that in the control group, but the difference was not statistically significant (P 0.05). 2. The VAS score of the two groups was significantly lower than that before treatment on the 1st day after treatment, the difference was statistically significant (P 0.01), and there was no significant difference between 1 day, 3 months and 6 months after treatment (P 0.05). There was no significant difference between the two groups at each time point (P 0.05). 3. The ODI index in the study group and the control group was significantly lower than that before operation, and 6 months after operation was significantly lower than that before operation and 3 months after operation, the difference was statistically significant (P 0.01). There was no significant difference between the two groups before operation, 3 months after operation and 6 months after operation (P 0.05). 4. The scores of 3 months and 6 months after operation in the study group and the control group were higher than those before operation, and the scores at 3 months and 6 months after operation were significantly higher than those at 1 day after operation (p0.01), but there was no significant difference between 3 months and 6 months after operation (p0.05). There was no significant difference in lehmann lumbar function score between the groups before operation, 1 day after operation, 3 months after operation and 6 months after operation (p0.05). 5.joa score in the study group and the control group at 6 months after operation were significantly higher than those before treatment, the difference was statistically significant (p0.01). There was no significant difference in joa score between the two groups before and 6 months after operation (p0.05). 6. The excellent and good rate of the improved macnab score was 87.5% in the control group and 92.5% in the study group. There was no significant difference in the excellent and good rate between the two groups (p0.05), and there was no significant difference in the therapeutic effect between the two groups (p0.05). Compared with the control group and the study group at 3 months after operation, the height of intervertebral space decreased by (8.04 卤1.69)% and (2.64 卤0.72)%, respectively, with significant difference (p0.01). 8 months after operation, the height of intervertebral space in the control group and the study group was (8.04 卤1.69)% and (2.64 卤0.72)%, respectively. The incidence of complications in the study group and the control group was 12.5% and 17.5%, respectively. there was no significant difference in the incidence of complications between the two groups (蠂 2 = 0.392, p 鈮，
本文编号：2500061
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