目的:观察核心稳定训练方案在腰椎间盘突出症(lumbar disc herniation,LDH)患者行经皮内镜下腰椎髓核摘除术(percutaneous endoscopic lumbar discectomy,PELD)术后康复中的效果,探讨中西医结合模式对术后残余症状的改善作用。方法:选取...目的:观察核心稳定训练方案在腰椎间盘突出症(lumbar disc herniation,LDH)患者行经皮内镜下腰椎髓核摘除术(percutaneous endoscopic lumbar discectomy,PELD)术后康复中的效果,探讨中西医结合模式对术后残余症状的改善作用。方法:选取100例LDH患者作为研究对象,按随机数字表法分为对照组和观察组,每组50例。对照组术后行12个月常规康复训练,观察组术后在对照组基础上增加系统核心稳定训练。比较两组患者治疗前后视觉模拟评分(visual analogue scale,VAS)、腰椎Oswestry功能障碍指数(oswestry dysfunction index of the lumbar spine,ODI)、Berg平衡量表(berg balance scale,BBS)评分及计时起立-行走测试(time up and go test,TUGT)时间,同时对比不良反应发生情况。结果:两组术前VAS评分、ODI指数比较,差异无统计学意义(P>0.05)。观察组术后1、3、12个月VAS评分、ODI指数及TUGT时间均低于对照组,差异有统计学意义(P<0.05);观察组术后1、3、12个月BBS评分均高于对照组,差异有统计学意义(P<0.05);观察组总并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论:核心稳定训练应用于LDH患者PELD术后康复,可减轻术后疼痛、麻木及无力等残余症状,提高平衡能力与腰椎功能,促进患者快速康复并提升手术满意度。核心稳定训练联合中医综合疗法可进一步缓解术后疼痛、改善气血运行、促进腰椎功能恢复,彰显中西医结合康复的优势。展开更多
目的:系统分析PETD与PEID治疗单节段LDH的相关的术中情况及术后疗效。方法:对Pub-Med、Med of science、中国期刊全文数据库(CNKI)、维普数据库、万方数据库进行关于PELD相关文献进行检索,语种为英文或中文。由两位作者独立对各研究进...目的:系统分析PETD与PEID治疗单节段LDH的相关的术中情况及术后疗效。方法:对Pub-Med、Med of science、中国期刊全文数据库(CNKI)、维普数据库、万方数据库进行关于PELD相关文献进行检索,语种为英文或中文。由两位作者独立对各研究进行评估,并将各数据导入Revman 5.3软件进行Meta分析,来评估两种入路技术在各种结局指标的统计学意义。结果:最终共计15篇研究被纳入,共计1422例患者被纳入分析。PETD与PEID比较:后者手术时间更短(MD = 6.11, 95% CI: −1.86~14.07),而差异不存在统计学意义(P > 0.05);PEID术中X光线透视次数更少(MD = 9.05, 95% CI: 7.17~10.92, P 0.05);两组的术后1天腰痛VAS变化值(MD = −0.04, 95% CI: −0.34~0.27),ODI变化值(MD = −0.64, 95% CI: −0.22~0.95)、术后1月腰痛VAS变化值(MD = −0.04, 95% CI: −0.34~0.27)和ODI变化值(MD = 0.21, 95% CI: −1.08~1.49)、术后3月腰痛VAS变化值(MD = −0.05, 95% CI: −0.24~0.14)和ODI变化值(MD = −0.88, 95% CI: −1.95~0.19)、术后6月腰痛VAS变化值(MD = 0.04, 95% CI: −0.20~0.29)和ODI变化值(MD = 0.61, 95% CI: −1.31~2.53)、术后12月腰痛VAS变化值(MD = 0.05, 95% CI: −0.09~0.19)和ODI变化值(MD = −0.20, 95% CI: −0.95~0.56),均无统计学意义(P > 0.05)。结论:PETD和PEID治疗单节段LDH均具有良好的临床疗效,但PEID术中X光线透视次数更少,且手术时间可能更短。PETD更具微创性,能够更少破坏脊柱骨性结构,短期内更好地缓解腰腿痛。Objective: To systematically analyze the intraoperative and postoperative effects of two approaches of percutaneous spinal endoscopy in the treatment of lumbar disc herniation. Methods: Clinical studies related to PELD were searched in English or Chinese by Pub-Med, Med of Science, China Journal Full-text Database (CNKI), VIP database and Wanfang database. Two authors independently assessed the quality of each study, and a meta-analysis of each data was performed using Revman 5.3 software to evaluate the statistical significance of the two approach techniques in various outcome indicators. Results: A total of 15 studies were eventually included, with a total of 1422 patients included in the analysis. Comparison between PETD and PEID: the operation time of the latter group was shorter than that of the former group (MD = 6.11, 95% CI: −1.86~14.07), but the difference was not statistically significant (P > 0.05). The latter had fewer intraoperative fluoroscopy times than the former (MD = 9.05, 95% CI: 7.17~10.92, P 0.05). VAS change value of low back pain 1 day after surgery (MD = −0.04, 95% CI: −0.34~0.27), ODI change value (MD = −0.64, 95% CI: −0.22~0.95), VAS change value of low back pain 1 month after surgery (MD = −0.04, 95% CI: −0.34~0.27) and ODI (MD = 0.21, 95% CI: −1.08~1.49), VAS change value of low back pain 3 months after surgery (MD = −0.05, 95% CI: −0.24~0.14) and ODI change value (MD = −0.88, 95% CI: −1.95~0.19), the change of VAS for low back pain 6 months after surgery (MD = 0.04, 95% CI: −0.20~0.29) and ODI change value (MD = 0.61, 95% CI: −1.31~2.53), the change of VAS for low back pain 12 months after surgery (MD = 0.05, 95% CI: −0.09~0.19) and ODI change value (MD = −0.20, 95% CI: −0.95~0.56) were not statistically significant (P > 0.05). Conclusion: Both PETD and PEID have good clinical efficacy in the treatment of lumbar disc herniation, but PEID may have shorter operative time and fewer intraoperative X-ray times. PETD is more minimally invasive, can destroy less spinal bone structure, and can better relieve back and leg pain in the short term.展开更多
文摘目的:观察核心稳定训练方案在腰椎间盘突出症(lumbar disc herniation,LDH)患者行经皮内镜下腰椎髓核摘除术(percutaneous endoscopic lumbar discectomy,PELD)术后康复中的效果,探讨中西医结合模式对术后残余症状的改善作用。方法:选取100例LDH患者作为研究对象,按随机数字表法分为对照组和观察组,每组50例。对照组术后行12个月常规康复训练,观察组术后在对照组基础上增加系统核心稳定训练。比较两组患者治疗前后视觉模拟评分(visual analogue scale,VAS)、腰椎Oswestry功能障碍指数(oswestry dysfunction index of the lumbar spine,ODI)、Berg平衡量表(berg balance scale,BBS)评分及计时起立-行走测试(time up and go test,TUGT)时间,同时对比不良反应发生情况。结果:两组术前VAS评分、ODI指数比较,差异无统计学意义(P>0.05)。观察组术后1、3、12个月VAS评分、ODI指数及TUGT时间均低于对照组,差异有统计学意义(P<0.05);观察组术后1、3、12个月BBS评分均高于对照组,差异有统计学意义(P<0.05);观察组总并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论:核心稳定训练应用于LDH患者PELD术后康复,可减轻术后疼痛、麻木及无力等残余症状,提高平衡能力与腰椎功能,促进患者快速康复并提升手术满意度。核心稳定训练联合中医综合疗法可进一步缓解术后疼痛、改善气血运行、促进腰椎功能恢复,彰显中西医结合康复的优势。
文摘目的:系统分析PETD与PEID治疗单节段LDH的相关的术中情况及术后疗效。方法:对Pub-Med、Med of science、中国期刊全文数据库(CNKI)、维普数据库、万方数据库进行关于PELD相关文献进行检索,语种为英文或中文。由两位作者独立对各研究进行评估,并将各数据导入Revman 5.3软件进行Meta分析,来评估两种入路技术在各种结局指标的统计学意义。结果:最终共计15篇研究被纳入,共计1422例患者被纳入分析。PETD与PEID比较:后者手术时间更短(MD = 6.11, 95% CI: −1.86~14.07),而差异不存在统计学意义(P > 0.05);PEID术中X光线透视次数更少(MD = 9.05, 95% CI: 7.17~10.92, P 0.05);两组的术后1天腰痛VAS变化值(MD = −0.04, 95% CI: −0.34~0.27),ODI变化值(MD = −0.64, 95% CI: −0.22~0.95)、术后1月腰痛VAS变化值(MD = −0.04, 95% CI: −0.34~0.27)和ODI变化值(MD = 0.21, 95% CI: −1.08~1.49)、术后3月腰痛VAS变化值(MD = −0.05, 95% CI: −0.24~0.14)和ODI变化值(MD = −0.88, 95% CI: −1.95~0.19)、术后6月腰痛VAS变化值(MD = 0.04, 95% CI: −0.20~0.29)和ODI变化值(MD = 0.61, 95% CI: −1.31~2.53)、术后12月腰痛VAS变化值(MD = 0.05, 95% CI: −0.09~0.19)和ODI变化值(MD = −0.20, 95% CI: −0.95~0.56),均无统计学意义(P > 0.05)。结论:PETD和PEID治疗单节段LDH均具有良好的临床疗效,但PEID术中X光线透视次数更少,且手术时间可能更短。PETD更具微创性,能够更少破坏脊柱骨性结构,短期内更好地缓解腰腿痛。Objective: To systematically analyze the intraoperative and postoperative effects of two approaches of percutaneous spinal endoscopy in the treatment of lumbar disc herniation. Methods: Clinical studies related to PELD were searched in English or Chinese by Pub-Med, Med of Science, China Journal Full-text Database (CNKI), VIP database and Wanfang database. Two authors independently assessed the quality of each study, and a meta-analysis of each data was performed using Revman 5.3 software to evaluate the statistical significance of the two approach techniques in various outcome indicators. Results: A total of 15 studies were eventually included, with a total of 1422 patients included in the analysis. Comparison between PETD and PEID: the operation time of the latter group was shorter than that of the former group (MD = 6.11, 95% CI: −1.86~14.07), but the difference was not statistically significant (P > 0.05). The latter had fewer intraoperative fluoroscopy times than the former (MD = 9.05, 95% CI: 7.17~10.92, P 0.05). VAS change value of low back pain 1 day after surgery (MD = −0.04, 95% CI: −0.34~0.27), ODI change value (MD = −0.64, 95% CI: −0.22~0.95), VAS change value of low back pain 1 month after surgery (MD = −0.04, 95% CI: −0.34~0.27) and ODI (MD = 0.21, 95% CI: −1.08~1.49), VAS change value of low back pain 3 months after surgery (MD = −0.05, 95% CI: −0.24~0.14) and ODI change value (MD = −0.88, 95% CI: −1.95~0.19), the change of VAS for low back pain 6 months after surgery (MD = 0.04, 95% CI: −0.20~0.29) and ODI change value (MD = 0.61, 95% CI: −1.31~2.53), the change of VAS for low back pain 12 months after surgery (MD = 0.05, 95% CI: −0.09~0.19) and ODI change value (MD = −0.20, 95% CI: −0.95~0.56) were not statistically significant (P > 0.05). Conclusion: Both PETD and PEID have good clinical efficacy in the treatment of lumbar disc herniation, but PEID may have shorter operative time and fewer intraoperative X-ray times. PETD is more minimally invasive, can destroy less spinal bone structure, and can better relieve back and leg pain in the short term.
