本文選題：經(jīng)皮椎間孔鏡腰椎間盤突出髓核摘出術(shù) + 腰椎間盤突出癥��； 參考：《湖北中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的:觀察經(jīng)皮椎間孔鏡治療腰椎間盤突出癥時對神經(jīng)根伴行血管保留與患者術(shù)后不適感及麻木感改善程度的關(guān)系。方法:回顧性分析2014年1月至2015年12月期間,廣州軍區(qū)武漢總醫(yī)院骨科脊柱病區(qū)收治的133例腰椎間盤突出癥患者,均在局麻+監(jiān)護下行經(jīng)皮椎間孔鏡下髓核摘除手術(shù),術(shù)中保存視頻顯示,有71例患者術(shù)中完整保留神經(jīng)根伴行血管,62例患者未保留。觀察患者術(shù)后不適感及患肢麻木感,統(tǒng)計手術(shù)時間,采用視覺模擬量表(VAS)評分評估患者術(shù)前與術(shù)后當(dāng)天、術(shù)后三天、術(shù)后1月、術(shù)后三月、術(shù)后一年的腰腿痛緩解情況;腰椎JOA功能評分(29分法)評估術(shù)前與術(shù)后當(dāng)天、術(shù)后三天、術(shù)后1月、術(shù)后三月、術(shù)后一年的癥狀緩解情況;ODI傷殘指數(shù)(Oswestry disability index,ODI)功能評分對術(shù)前與術(shù)后1月、術(shù)后三月、術(shù)后一年腰椎功能進行評估結(jié)果:133例患者均順利完成手術(shù),無術(shù)中更改術(shù)式,術(shù)中均無神經(jīng)根損傷及腦脊液漏,術(shù)后患者腰腿疼痛緩解,無椎間隙感染等并發(fā)癥發(fā)生。通過定期門診復(fù)查、電話聯(lián)系和E—mail隨訪,133例患者術(shù)后三個月內(nèi)全部獲得隨訪,其中110例患者隨訪1年以上,術(shù)后一年保留組失訪16例,失訪率22.5%,未保留組失訪7例,失訪率11.3%,均隨訪3～22個月,平均14.5個月。保留神經(jīng)根伴行血管組手術(shù)時間55～110min,平均71.5min;未保留神經(jīng)根伴行血管組手術(shù)時間為54～82min,平均為62.1min,兩組進行組間比較手術(shù)時間有統(tǒng)計學(xué)差異(P0.05)。保留組與未保留組手術(shù)前后直腿抬高試驗,術(shù)后住院天數(shù)比較無統(tǒng)計學(xué)意義(P0.05)。保留組患者術(shù)后各階段VAS評分、JOA評分、ODI評分與術(shù)前VAS評分、JOA評分、ODI評分比較均有統(tǒng)計學(xué)差異(P0.05)。未保留組患者術(shù)后各階段VAS評分、JOA評分、ODI評分與術(shù)前VAS評分、JOA評分、ODI評分比較均有統(tǒng)計學(xué)差異(P0.05)。兩組術(shù)后VAS評分、JOA評分及ODI評分進行組間比較,采用方差齊性檢驗,均滿足正態(tài)分布,進行兩組獨立樣本t檢驗,兩組術(shù)后VAS、JOA評分組間比較有統(tǒng)計學(xué)意義(P0.05),術(shù)后ODI評分組間比較無統(tǒng)計學(xué)意義(P0.05)。結(jié)論:經(jīng)皮椎間孔鏡在治療腰椎間盤突出癥,具有靶向精準(zhǔn)、創(chuàng)傷小,術(shù)后恢復(fù)快,手術(shù)時間較短,并發(fā)癥少,對脊柱穩(wěn)定性影響小,近期療效可靠等優(yōu)點;術(shù)中完整保留了神經(jīng)根伴行血管的患者,術(shù)后出現(xiàn)腰腿部不適感及患肢麻木感較未保留的患者輕,近期療效顯著。
[Abstract]:Objective: to observe the relationship between the nerve root and vascular preservation in the treatment of lumbar disc herniation by percutaneous foraminal endoscopy and the improvement of postoperative discomfort and numbness. Methods: from January 2014 to December 2015, 133 patients with lumbar intervertebral disc herniation (LIDP) treated in Department of Orthopaedics, Wuhan General Hospital of Guangzhou military region were analyzed retrospectively. During the operation, 71 patients with intact nerve root preservation accompanied by vascularization were not preserved. The postoperative discomfort and numbness of the affected limbs were observed and the time of operation was counted. Visual analogue scale (VASS) was used to evaluate the relief of low back and leg pain before and after operation, three days after operation, one month after operation, three months after operation and one year after operation. Lumbar JOA score (29 points) was used to evaluate the symptom relief of preoperative and postoperative day, 3 days, 1 month, 3 months after operation and one year after operation. The scores of Oswestry disability index (ODI) were evaluated before and 1 month after operation, 3 months after operation, 3 months after operation, 1 month after operation, 3 months after operation, and 1 month after operation. Results one year after operation, 133 cases of lumbar vertebrae function were successfully operated without any change of operation, no nerve root injury and cerebrospinal fluid leakage, pain relief of lumbar and leg, and no complications such as intervertebral space infection. Through regular outpatient examination, telephone contact and E-mail follow-up all 133 patients were followed up within 3 months after operation. 110 cases were followed up for more than one year, 16 cases were lost in the retention group one year after operation, the missing rate was 22.5%, and 7 cases in the unretained group. All the patients were followed up for 3 ~ 22 months (mean 14.5 months). The operation time of the nerve root concomitant vascular group was 55 ~ 110min (mean 71.5 mins), while that of the unpreserved nerve root with vascular group was 54 ~ 82min (mean 62.1 mins). There was significant difference in the operation time between the two groups (P 0.05). There was no significant difference in the length of hospitalization between the retention group and the unreserved group before and after operation (P 0.05). In the retention group, there were significant differences between the VAS score and the preoperative VAS score and the preoperative VAS score and ODI score in each stage of the operation (P 0.05). There were significant differences in VAS scores and VAS scores between the patients in the unreserved group and those in the preoperative VAS scores and the preoperative VAS scores (P 0.05). The VAS scores and ODI scores were compared between the two groups after operation. The variance homogeneity test was used to satisfy the normal distribution, and the two groups of independent samples were tested by t test. There was significant difference between the two groups (P 0.05), but there was no significant difference between the two groups in ODI score (P 0.05). Conclusion: percutaneous foramen endoscopy has many advantages in the treatment of lumbar disc herniation, such as precise target, small trauma, quick recovery, short operation time, less complications, little influence on spine stability, reliable short-term curative effect, etc. The patients with intact nerve root and blood vessels had less discomfort and numbness in the waist and leg after operation than the patients without preserving the nerve root. The short-term curative effect was remarkable.
【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R687.3

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