本文選題：椎間孔鏡 + 顯微內窺鏡��； 參考：《廣西中醫(yī)藥大學》2017年碩士論文

【摘要】：目的:通過本隨訪比較經(jīng)皮椎間孔鏡下腰椎間盤切除術(percutaneous endoscopic lumbar discectomy,PELD)與后路顯微內窺鏡下腰椎間盤切除術(microendoscopic discectomy,MED)治療腰椎間盤突出癥(lumbar disc herniation,LDH)的臨床指標,為臨床治療LDH方案選擇提供借鑒意義。方法:選取2014年10月至2016年08月60例確診為單節(jié)段腰椎間盤突出癥的收治住院患者,根據(jù)手術方式分為PELD組和MED組,通過記錄兩組病例患者體重指數(shù)、年齡因素、患者病程長短、中醫(yī)證型、術后住院時間,術后按中醫(yī)證型給予患者口服院內制劑膏方,術后采用視覺模擬量表(visual analogue scale,VAS)評分、JOA和Oswestry功能障礙指數(shù)(Oswestry disability index,ODI)進行隨訪,所得結果進行統(tǒng)計學分析評估療效。結果:隨訪到59例。MED組28例,PELD組31例。1.基本資料對比:經(jīng)單因素方差分析,兩組間患者年齡、體重指數(shù)和病程分布無差異無統(tǒng)計學意義(P0.05),提示兩組患者的年齡、體重指數(shù)及病程構成比無明顯差異。兩組間性別構成比較差異無統(tǒng)計學意義(P0.05)。2.兩組手術出血量、住院時間組間對比:住院時間、術中出血量組間對比差異有統(tǒng)計學意義(P0.05),提示PELD組在住院時間及術中出血量方面優(yōu)于MED組。3.MED組和PELD組組內前后療效評分分別對比:兩組在手術前、手術后組內比較顯示,根據(jù)腰椎JOA,VAS,ODI評分差異有統(tǒng)計學意義(P0.05),MED組和PELD組手術后癥狀及功能較術前均效果顯著,說明術后患者癥狀有明顯好轉。4.MED組與PELD組組間手術前后療效評分對比:組間比較顯示,兩組腰椎JOA,VAS,ODI評分組間對比評分無統(tǒng)計學意義(P0.05),兩組術后病人療效比較無明顯區(qū)別,MED組與PELD組在隨訪期間內取得了相似的臨床療效,兩組比較手術后3天VAS評分有統(tǒng)計學意義(P0.05),差異有顯著性,說明PELD組術后患者疼痛癥狀3天內明顯好于MED組。5.MED組與PELD組不同年齡段,體重指數(shù),中醫(yī)證型療效評分對比顯示:兩組腰椎JOA改善率,末次ODI評分組組間對比評分無統(tǒng)計學意義(P0.05),兩組術后病人療效比較無顯著差異,MED組與PELD組在不同年齡段,體重指數(shù),中醫(yī)證型療效差異研究中未體現(xiàn)療效差異。結論:1.本研究兩種治療措施PELD和MED均對治療腰椎間盤突出癥引起的腰腿痛均有效且效果相當,PELD和MED的療效差異還不能明確,只有嚴格把握適應癥和突破學習曲線后熟練操作才能得到最佳療效。2.體現(xiàn)微創(chuàng)上PELD相比MED具有短期疼痛改善快,術中出血少,術后住院短,術后恢復快等優(yōu)勢,對于腰椎穩(wěn)定性尚可的老年患者,PELD可取得滿意的療效。
[Abstract]:Objective: to compare the clinical indexes of percutaneous endoscopic lumbar discectomylotomy (endoscopic lumbar) and microendoscopic discectomy (endoscopic lumbar) in the treatment of lumbar intervertebral disc herniation (LIDH). To provide a reference for clinical treatment of LDH regimen selection. Methods: from October 2014 to August 2016, 60 inpatients with single segment lumbar disc herniation were selected and divided into PELD group and MED group according to the operation method. The body mass index and age factors of the two groups were recorded. The duration of the disease, the type of TCM syndromes, the duration of hospitalization after operation, and the oral preparation ointment were given to the patients according to the type of TCM syndromes. The visual analogue scale (VAS) score and the index of Oswestry dysfunction (Oswestry disability index ODI) were followed up after operation. The results were evaluated by statistical analysis. Results: a follow-up of 59 cases. MED group 28 cases of PELD group 31 cases. 1. Comparison of basic data: there was no significant difference in age, body mass index and course of disease distribution between the two groups by univariate ANOVA, indicating that there was no significant difference in age, body mass index and the proportion of course of disease between the two groups. There was no significant difference in sex composition between the two groups (P 0.05. 2). The amount of blood lost in operation and the length of hospitalization were compared between the two groups: length of stay, The difference of intraoperative bleeding volume was statistically significant (P 0.05), which suggested that PELD group was better than MED group in terms of hospitalization time and intraoperative bleeding volume. 3. The scores of curative effect before and after operation in MED group and PELD group were compared: the comparison between the two groups before and after operation showed that: 1. According to the difference in the scores of VAS-ODI of lumbar vertebrae, there was significant difference in the symptoms and functions after operation in P0.05 and PELD groups, which indicated that the symptoms of the patients after operation were obviously improved. 4. The scores of pre-and post-operation efficacy between MED group and PELD group were compared: the comparison between the two groups showed that the symptoms and functions of the two groups were significantly better than those of before and after operation. There was no significant difference in the scores between the two groups (P 0.05). There was no significant difference in the curative effect between the two groups. Similar clinical results were obtained between the MED group and the PELD group during the follow-up period. There was a significant difference in VAS scores between the two groups at 3 days after operation, which indicated that the pain symptoms in PELD group were significantly better than those in MED group and PELD group within 3 days, and the body mass index (BMI) was significantly better than that in MED group and PELD group. The scores of TCM syndromes showed that the improvement rate of lumbar JOA was not significant in the last ODI score group, and there was no significant difference in the curative effect between the two groups. There was no significant difference between the two groups in terms of age, body mass index (BMI), body mass index (BMI). The difference of curative effect was not reflected in the study of the difference of TCM syndromes. Conclusion 1. In this study, both PELD and MED were effective in the treatment of lumbago and leg pain caused by lumbar disc herniation. Only by mastering the indication and breaking through the learning curve can we get the best curative effect. 2. Compared with MED, minimally invasive PELD has the advantages of quick improvement of short-term pain, less intraoperative bleeding, short hospital stay and quick postoperative recovery. It can obtain satisfactory curative effect for elderly patients with stable lumbar vertebrae.
【學位授予單位】：廣西中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.3

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