【摘要】：目的觀察經(jīng)皮椎間孔鏡椎間盤切除術(shù)(PTED)與小切口椎板開窗術(shù)治療腰椎間盤突出癥的手術(shù)指標、近期療效和并發(fā)癥發(fā)生情況,探討經(jīng)PTED在腰椎間盤突出癥中的應(yīng)用價值。方法選取2014年6月-2015年5月在我院就診的腰椎間盤突出患者80例進行研究,患者被簡單隨機化法隨機分為研究組和對照組各40例,對照組采用小切口椎板開窗術(shù)治療,研究組采用PTED治療。觀察兩組患者的手術(shù)時間、術(shù)中出血量、切口長度、并發(fā)癥發(fā)生率等及3月時椎間隙降低情況。術(shù)前、術(shù)后1d、術(shù)后3月、術(shù)后6月觀察兩組患者的VAS評分;術(shù)前、術(shù)后6月評定患者的JOA評分;術(shù)前、術(shù)后3月、術(shù)后6月評定患者的ODI評分和Lehmann腰椎功能評分;術(shù)后6月采用改良MacNab標準進行療效評價。結(jié)果1.手術(shù)相關(guān)指標研究組和對照組手術(shù)時間、切口長度、術(shù)中出血量、咬骨體積、臥床時間、住院時間等指標差異均有統(tǒng)計學意義(P0.01)。研究組住院總花費為高于對照組,但差異無統(tǒng)計學意義(P0.05)。2.VAS評分兩組治療后1d較治療前VAS評分顯著降低,差異有統(tǒng)計學意義(P0.01),術(shù)后1d、3月、6月間比較差異均無統(tǒng)計學意義(P0.05)。各時間點組間對比差異均無統(tǒng)計學意義(P0.05)。3.ODI指數(shù)研究組和對照組兩組術(shù)后3月均明顯低于術(shù)前,術(shù)后6月明顯低于術(shù)前和術(shù)后3月,差異均有統(tǒng)計學意義(P0.01)。兩組術(shù)前、術(shù)后3月和術(shù)后6月組間對比差異均無統(tǒng)計學意義(P0.05)。4.lehmann腰椎功能評分研究組和對照組兩組術(shù)后1d、3月和6月的評分均高于術(shù)前,術(shù)后3月和6月評分高于術(shù)后1d,差異均有統(tǒng)計學意義(p0.01),術(shù)后3月和6月評分差異無統(tǒng)計學意義(p0.05)。術(shù)前、術(shù)1d、術(shù)后3月和術(shù)后6月組間lehmann腰椎功能評分差異均無統(tǒng)計學意義(p0.05)。5.joa評分研究組和對照組術(shù)后6月joa評分均高于治療前,差異有統(tǒng)計學意義(p0.01)。術(shù)前、術(shù)后6月兩組的joa評分差異均無統(tǒng)計學意義(p0.05)。6.改良macnab評分療效對照組優(yōu)良率為87.5%;研究組優(yōu)良率為92.5%。兩組優(yōu)良率比較差異無統(tǒng)計學意義(p0.05),兩組治療效果比較差異無統(tǒng)計學意義(p0.05)。7.3個月椎間隙高度降低比較術(shù)后3個月對照組和研究組椎間隙高度降低分別為(8.04±1.69)%和(2.64±0.72)%,差異有顯著統(tǒng)計學意義(p0.01)。8.并發(fā)癥研究組和對照組的并發(fā)癥發(fā)生率分別為12.5%和發(fā)生率為17.5%,兩組并發(fā)癥發(fā)生率差異無統(tǒng)計學意義(χ2=0.392,p=0.531)。結(jié)論經(jīng)皮椎間孔tessys技術(shù)和小切口椎板間開窗治療ldh均可取得良好的效果,經(jīng)皮椎間孔tessys技術(shù)在微創(chuàng)方面更具優(yōu)勢,值得臨床推廣應(yīng)用。
[Abstract]:Objective to observe the surgical indexes, short-term curative effect and complications of (PTED) and small incision lamina fenestration in the treatment of lumbar disc herniation, and to explore the value of PTED in the treatment of lumbar disc herniation. Methods from June 2014 to May 2015, 80 patients with lumbar disc protrusion were randomly divided into study group (n = 40) and control group (n = 40). The control group was treated with small incision lamina fenestration and the study group was treated with PTED. The operation time, intraoperative blood loss, incision length, incidence of complications and the decrease of intervertebral space at 3 months were observed. The VAS scores of the two groups were observed before, 1 day, 3 months and 6 months after operation, the JOA scores of the patients were evaluated before and 6 months after operation, the ODI scores and Lehmann lumbar function scores of the patients were evaluated before, 3 months and 6 months after operation, and the curative effect was evaluated by modified MacNab standard 6 months after operation. Result 1. There were significant differences in operation time, incision length, intraoperative blood loss, occlusal volume, bed rest time and hospitalization time between the study group and the control group (P 0.01). The total cost of hospitalization in the study group was higher than that in the control group, but the difference was not statistically significant (P 0.05). 2. The VAS score of the two groups was significantly lower than that before treatment on the 1st day after treatment, the difference was statistically significant (P 0.01), and there was no significant difference between 1 day, 3 months and 6 months after treatment (P 0.05). There was no significant difference between the two groups at each time point (P 0.05). 3. The ODI index in the study group and the control group was significantly lower than that before operation, and 6 months after operation was significantly lower than that before operation and 3 months after operation, the difference was statistically significant (P 0.01). There was no significant difference between the two groups before operation, 3 months after operation and 6 months after operation (P 0.05). 4. The scores of 3 months and 6 months after operation in the study group and the control group were higher than those before operation, and the scores at 3 months and 6 months after operation were significantly higher than those at 1 day after operation (p0.01), but there was no significant difference between 3 months and 6 months after operation (p0.05). There was no significant difference in lehmann lumbar function score between the groups before operation, 1 day after operation, 3 months after operation and 6 months after operation (p0.05). 5.joa score in the study group and the control group at 6 months after operation were significantly higher than those before treatment, the difference was statistically significant (p0.01). There was no significant difference in joa score between the two groups before and 6 months after operation (p0.05). 6. The excellent and good rate of the improved macnab score was 87.5% in the control group and 92.5% in the study group. There was no significant difference in the excellent and good rate between the two groups (p0.05), and there was no significant difference in the therapeutic effect between the two groups (p0.05). Compared with the control group and the study group at 3 months after operation, the height of intervertebral space decreased by (8.04 鹵1.69)% and (2.64 鹵0.72)%, respectively, with significant difference (p0.01). 8 months after operation, the height of intervertebral space in the control group and the study group was (8.04 鹵1.69)% and (2.64 鹵0.72)%, respectively. The incidence of complications in the study group and the control group was 12.5% and 17.5%, respectively. there was no significant difference in the incidence of complications between the two groups (蠂 2 = 0.392, p 鈮，

本文編號：2500061