本文選題：腰椎間盤突出癥 + 顯微內(nèi)窺鏡下椎間盤髓核摘除術(shù)�。� 參考：《中國(guó)脊柱脊髓雜志》2017年03期

【摘要】：目的 :評(píng)價(jià)顯微內(nèi)窺鏡下腰椎間盤髓核摘除聯(lián)合纖維環(huán)縫合治療腰椎間盤突出癥(LDH)的安全性、臨床療效以及術(shù)后復(fù)發(fā)率。方法:回顧性分析我院2012年3月~2014年3月接受顯微內(nèi)窺鏡下腰椎間盤髓核摘除術(shù)(MED)治療的290例單節(jié)段LDH患者,男160例,女130例,年齡20~66歲(38.1±12.1歲)。其中172例單純行MED(對(duì)照組),118例行MED聯(lián)合纖維環(huán)縫合術(shù)(縫合組)。兩組患者的年齡、性別比、體重指數(shù)、手術(shù)節(jié)段、突出類型及隨訪時(shí)間無法無統(tǒng)計(jì)學(xué)差異(P0.05),記錄兩組患者手術(shù)時(shí)間、出血量、術(shù)前及隨訪時(shí)疼痛視覺模擬量表(VAS)評(píng)分、Oswestry功能障礙指數(shù)(ODI)。利用影像學(xué)資料測(cè)量術(shù)前及隨訪時(shí)手術(shù)節(jié)段椎間隙高度。結(jié)果:兩組患者平均手術(shù)時(shí)間和平均手術(shù)出血量比較均無統(tǒng)計(jì)學(xué)差異(P0.05)。隨訪24~32個(gè)月(28.35±5.08個(gè)月),兩組組內(nèi)ODI評(píng)分、腰痛VAS評(píng)分、下肢痛VAS評(píng)分術(shù)前與術(shù)后3個(gè)月、末次隨訪時(shí)比較均有統(tǒng)計(jì)學(xué)差異(P0.05),同時(shí)間點(diǎn)兩組間比較無統(tǒng)計(jì)學(xué)差異(P0.05)。對(duì)照組末次隨訪時(shí)椎間隙高度(8.29±1.43mm)較術(shù)前(10.34±1.74mm)降低19.83%,縫合組末次隨訪椎間隙高度(8.94±1.35mm)較術(shù)前(10.46±1.55mm)降低14.53%,兩組組間比較無統(tǒng)計(jì)學(xué)差異(P0.05)。對(duì)照組術(shù)后同節(jié)段復(fù)發(fā)14例,復(fù)發(fā)率為8.14%,再手術(shù)患者6例,再手術(shù)率3.49%;縫合組術(shù)后3例患者復(fù)發(fā),復(fù)發(fā)率為2.54%,再手術(shù)患者1例,再手術(shù)率為0.85%。兩組復(fù)發(fā)率和再手術(shù)率比較有統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論:顯微內(nèi)窺鏡下椎間盤髓核摘除纖維環(huán)縫合術(shù)治療LDH操作簡(jiǎn)便、安全可行,可獲得滿意的臨床療效;在嚴(yán)格把握適應(yīng)證的條件下,可有效降低術(shù)后復(fù)發(fā)率及再手術(shù)率。
[Abstract]:Objective: to evaluate the safety, clinical effect and recurrence rate of microendoscopic lumbar disc nucleus pulpotomy combined with fiber ring suture in the treatment of lumbar disc herniation. Methods: from March 2012 to March 2014, 290 patients (160 males and 130 females) with single segment LDH treated by microendoscopic discectomy of nucleus pulposus were retrospectively analyzed. Their age was 20 ~ 66 years old and 38.1 鹵12.1 years old. Among them 172 cases were treated with MED alone (control group 118 cases) with MED combined with annular suture (suture group). There was no significant difference in age, sex ratio, body mass index, operative segment, protrusion type and follow-up time between the two groups (P 0.05). Preoperative and follow-up visual analogue scale (VAS) was used to evaluate Oswestry dysfunction index (Oswestry index). The height of the segmental intervertebral space was measured by imaging data before operation and during follow-up. Results: there was no significant difference between the two groups in the mean operative time and the mean blood loss (P 0.05). The follow-up time ranged from 24 to 32 months (28.35 鹵5.08 months). There were significant differences in ODI score, VAS score for low back pain and VAS score for lower extremity pain between the two groups before and after the last follow-up (P 0.05). There was no significant difference between the two groups at the same time point (P 0.05). In the control group, the height of intervertebral space was decreased by 8.29 鹵1.43mm at the last follow-up and 19.83mm by 10.34 鹵1.74mm. The height of intervertebral space was decreased by 8.94 鹵1.35mm at the last follow-up in the suture group. The height of intervertebral space was decreased by 14.53mm compared with that of the control group (10.46 鹵1.55mm). There was no significant difference between the two groups (P 0.05). In the control group, 14 cases had recurrence in the same segment, the recurrence rate was 8.14, and the reoperation rate was 3.49 in 6 patients with reoperation, while in the suture group, the recurrence rate was 2.54 and the reoperation rate was 0.85. There was significant difference in recurrence rate and reoperation rate between the two groups (P 0.05). Conclusion: microendoscopic discectomy and annular suture of intervertebral disc is simple, safe and feasible in the treatment of LDH, and it can effectively reduce the recurrence rate and reoperation rate under the condition of strict indication.
【作者單位】： 南方醫(yī)科大學(xué)第三附屬醫(yī)院脊柱外科;
【基金】：廣東省科技計(jì)劃項(xiàng)目(編號(hào):412018908043)
【分類號(hào)】：R687.3

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