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(P<0.05),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(P>0.05)。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(P>0.05),但各组与术前相比差异均有统计学意义(P<0.05)。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(P>0.05)。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(P>0.05)。[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。
[Objective] To compare the clinical outcomes of nerve root block combined with percutaneous transforaminal endoscopic discectomy versus traditional open discectomy for the treatment of atypical lumbar disc herniation （ALDH） . [Methods ] Of 52 patients with ALDH who were surgically treated from June 2012 to August 2014, 24 patients had percutane- ous transforaminal endoscopic discectomy （the minimal invasive group）, while the remaining 28 patients underwent tradition- al open discectomy （the traditional group） . Nerve root block were conducted in both groups for positioning and qualitative di- agnosis. The VAS, JOA, ODI scores and modified Macnab criteria were used for assessment of outcome. [Results] The min- imally invasive group was superior to the traditional group in blood loss volume, incision length, bed rest time and hospital stay, with significant differences （P〈0.05）, however the difference in operation time between them was not statistically sig- nificant （P〉0.05） . The VAS, JOA and ODI scores in both groups significantly improved after operation （P〈0.05）, but no differences was found in any parameter at the corresponding time point between the two groups （P〉0.05） . In term of the modi- fied Macnab criteria, the improvement rate of the two groups were 91.67% （22/24） versus 89.29% （25/28）, without a statis- tical difference （P〉0.05） . Furthermore, complication rate of the two groups proved 8.33% （2/24） versus 7.14% （2/28）,had no a significantly difference between them either （P〉 0.05） . [Conclusion] For atypical lumbar intervertebral disc herniation, nerve root block is effective for positioning and qualitative diagnosis. Both percutaneous transforaminal endoscopic discectomy and traditional open lumbar discectomy achieve satisfactory outcomes, but the former has advantages of minimal trauma, less blood loss, quicker recovery.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2017年第13期1164-1167,共4页
Orthopedic Journal of China
关键词
神经根阻滞
经皮椎间孔镜
不典型腰椎间盘突出症
nerve root block, percutaneous transforaminal endoscopic discectomy, atypical lumbar disc herniation
