本文選題：下腰痛 + 神經(jīng)根性病變��； 參考：《中國人民解放軍醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:觀察并評估經(jīng)皮內(nèi)鏡腰神經(jīng)根減壓術(shù)治療腰腿疼痛術(shù)后的疼痛改善情況。方法:對解放軍總醫(yī)院骨科2015年1月-2016年1月連續(xù)84例經(jīng)皮脊柱內(nèi)鏡腰神經(jīng)減壓術(shù)治療腰背痛和(或)神經(jīng)根性下肢痛的患者,前瞻隨訪兩種疼痛各自在術(shù)前、術(shù)后1-12周(1周1次)的VAS評分及末次隨訪時的改良MacNab療效評定,評估兩種疼痛各自在術(shù)后12周里的改善情況,比較兩者的疼痛改善度(術(shù)前VAS-末次隨訪VAS)和末次隨訪時的改良MacNab療效評定,用末次隨訪時ODI、腰背痛VAS、下肢痛VAS評分與術(shù)前比較評價全體患者的手術(shù)療效。結(jié)果:腰背痛術(shù)后1-12周VAS評分相鄰兩周間差異無統(tǒng)計(jì)學(xué)意義(P均0.05);下肢痛術(shù)后 VAS 評分第 2 周 vs 第 1 周[(2.96±1.97)分 vs(2.10±1.29)分、P0.05]、差異顯著,第 4 周 vs 第 3 周[(2.04±1.62)分 vs (2.46±1.97)分、P0.05]、差異顯著,余下相鄰兩周間差異無統(tǒng)計(jì)學(xué)意義(P0.05);下肢痛術(shù)后12周VAS改善度及改良MacNab優(yōu)良率均顯著優(yōu)于腰背痛[(6.64±1.47)分vs (3.36±1.38)分、86%vs73%,P0.05];全體患者末次隨訪ODI、腰背痛VAS、下肢痛VAS均較術(shù)前顯著降低[(12.82±6.39)分 vs (53.64±11.73)分、(1.16±1.06)分 vs (4.52±0.65)分、(1.29±1.30)分 vs (7.93±0.81)分,P 均0.05]。結(jié)論:經(jīng)皮內(nèi)鏡腰神經(jīng)根減壓術(shù)后12周患者腰背痛的改善平穩(wěn),而下肢痛的改善在術(shù)后第2周、3周出現(xiàn)波動,術(shù)前應(yīng)指導(dǎo)患者建立對手術(shù)效果和術(shù)后恢復(fù)的合理預(yù)期,術(shù)后應(yīng)觀察至少3周、其后是否有下降趨勢,可在術(shù)后第2、3周通過物理治療、藥物治療等進(jìn)行對癥處理。經(jīng)皮內(nèi)鏡腰神經(jīng)根減壓術(shù)適合治療以單側(cè)下肢根性疼痛為突出表現(xiàn)的腰椎退變疾病,軸性腰痛并非其最佳適應(yīng)癥。
[Abstract]:Objective: to observe and evaluate the improvement of pain after percutaneous endoscopic lumbar nerve root decompression for lumbar and leg pain. Methods: from January 2015 to January 2016, 84 consecutive patients with low back pain and / or nerve root pain were treated by percutaneous endoscopic lumbar nerve decompression. VAS score at 1-12 weeks after operation and modified MacNab evaluation at the last follow-up were used to evaluate the improvement of the two kinds of pain in 12 weeks postoperatively. The degree of pain improvement (preoperative VAS-last follow-up vs) and modified MacNab evaluation at the last follow-up were compared between the two groups. The surgical efficacy of all patients was evaluated with VAS score of LBP, LBP and VAS-LBP at the last follow-up. Results: there was no significant difference in the VAS score between the two weeks after the operation of low back pain (P < 0.05), and the VAS score in the second week after operation was significantly higher than that in the first week (P < 0.05) [2.96 鹵1.97) vs(2.10 鹵1.29 (P0.05)]. The fourth week vs the third week [2.04 鹵1.62) vs 2.46 鹵1.97], the difference was significant. There was no significant difference between the remaining two weeks (P 0.05), the improvement degree of VAS and the excellent and good rate of modified MacNab 12 weeks after operation were significantly better than those of low back pain [6.64 鹵1.47) vs 3.36 鹵1.38]. The score was decreased [12.82 鹵6.39) vs 53.64 鹵11.73) (1.16 鹵1.06) vs 4.52 鹵0.65) (1.29 鹵1.30) vs 7.93 鹵0.81 (P 0.05). Conclusion: the improvement of low back pain is stable at 12 weeks after percutaneous endoscopic lumbar nerve root decompression, while the improvement of lower extremity pain fluctuates at the second week after operation. It should be observed at least 3 weeks after the operation, then whether there is a downward trend or not, can be treated by physical therapy, drug therapy and so on in the 2nd week after operation. Percutaneous endoscopic lumbar nerve root decompression is suitable for the treatment of lumbar degenerative diseases characterized by unilateral lower limb root pain. Axial low back pain is not the best indication.
【學(xué)位授予單位】：中國人民解放軍醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3

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