【摘要】：目的:回顧性評(píng)價(jià)經(jīng)皮椎間孔鏡椎間盤(pán)切除術(shù)(PTED)和傳統(tǒng)椎板間擴(kuò)大開(kāi)窗術(shù)兩種手術(shù)方式治療腰椎間盤(pán)突出癥的短期臨床療效,分析比較PTED和傳統(tǒng)手術(shù)方式的優(yōu)勢(shì)與不足,為腰椎間盤(pán)突出癥的治療提供一定的臨床參考及理論依據(jù)。方法:統(tǒng)計(jì)自2014年1月~2014年12月在山東中醫(yī)藥大學(xué)附屬醫(yī)院脊柱骨科病房住院的腰椎間盤(pán)突出癥患者,并且分析其中的44例符合診斷標(biāo)準(zhǔn)及臨床研究納入標(biāo)準(zhǔn)并按時(shí)隨訪患者的臨床及影像學(xué)資料。按手術(shù)方式分為兩組,其中PTED組22例,開(kāi)窗組22例。分別記錄兩組患者術(shù)前、術(shù)中及術(shù)后資料,包括手術(shù)時(shí)間、術(shù)中出血量、椎間盤(pán)切除量、術(shù)后絕對(duì)臥床時(shí)間、住院時(shí)間以及術(shù)前、術(shù)后1月、術(shù)后3月JOA評(píng)分、VAS評(píng)分、ODI評(píng)分,對(duì)以上所得結(jié)果進(jìn)行統(tǒng)計(jì)學(xué)分析,并采用改良Macnab標(biāo)準(zhǔn)療效評(píng)定兩組術(shù)后3個(gè)月的臨床療效。結(jié)果:兩組患者均隨訪3個(gè)月以上,對(duì)2種手術(shù)療效進(jìn)行比較。PTED組患者臨床療效優(yōu)良率為90.91%,開(kāi)窗組優(yōu)良率為81.81%,在優(yōu)良率比較上PTED組優(yōu)于開(kāi)窗組;比較兩組的椎間盤(pán)切除量、術(shù)中出血量、術(shù)后絕對(duì)臥床時(shí)間等差異具有統(tǒng)計(jì)學(xué)意義,兩組術(shù)后1月、3月JOA、VAS及ODI評(píng)分與術(shù)前相比,其差異有顯著統(tǒng)計(jì)學(xué)意義,但兩組組間評(píng)分差異無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論:PTED是傳統(tǒng)手術(shù)的微創(chuàng)化,具有傳統(tǒng)術(shù)式與經(jīng)皮穿刺技術(shù)的優(yōu)勢(shì),能直接到達(dá)椎間盤(pán)突出位置,摘除病變髓核,解除其對(duì)脊髓及神經(jīng)根的壓迫,在減少手術(shù)創(chuàng)傷的同時(shí),達(dá)到與傳統(tǒng)術(shù)式相似療效,可作為單純腰椎間盤(pán)突出癥的有效治療方式。
[Abstract]:Objective: to evaluate the short-term clinical effect of percutaneous foraminal discectomy (PTED) and traditional interlaminar fenestration in the treatment of lumbar disc herniation. To provide a certain clinical reference and theoretical basis for the treatment of lumbar disc herniation. Methods: from January 2014 to December 2014, the patients with lumbar disc herniation in the spine orthopedic ward of the affiliated Hospital of Shandong University of traditional Chinese Medicine were analyzed. The clinical and imaging data of 44 patients who met the diagnostic criteria and clinical study inclusion criteria and were followed up on time were analyzed. There were 22 cases in PTED group and 22 cases in fenestration group. Preoperative, intraoperative and postoperative data were recorded, including operative time, intraoperative blood loss, discectomy volume, absolute bed-rest time after operation, hospitalization time, JOA score, VAS score and ODI score before and after 1 month and 3 months after operation. The results were statistically analyzed, and the modified Macnab criteria were used to evaluate the clinical efficacy of the two groups 3 months after operation. Results: the two groups were followed up for more than 3 months. The excellent and good rates of the two groups were 90.91 in the PTED group and 81.81 in the fenestration group. The PTED group was better than the fenestration group in the excellent and good rate, and the discectomy amount in the two groups was compared. There were significant differences in blood loss during operation and absolute bed-rest time between the two groups. The scores of JOA,VAS and ODI were significantly different from those before operation at 1 month and 3 months after operation, but there was no significant difference between the two groups. Conclusion: PTED is a minimally invasive operation with the advantages of traditional operation and percutaneous puncture. It can directly reach the position of disc herniation, remove the diseased nucleus pulposus, relieve the compression of spinal cord and nerve root, and reduce the surgical trauma at the same time. It can be used as an effective treatment for simple lumbar disc herniation.
【學(xué)位授予單位】：山東中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3

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