摘要
目的观察经皮椎间孔镜技术治疗腰椎间盘突出症(LDH)的疗效,并探讨与手术相关的影响因素。方法回顾性分析了2013-01-2014-12行经皮椎间孔镜技术治疗的100例LDH患者,术后随访7-25个月,对患者手术前后的VAS、JOA评分和术后疗效进行评定。将疗效为优、良者作为疗效佳组,疗效为可、差者作为疗效不佳组,作为自变量;对患者的年龄、性别、病程、有无外伤史、临床症状、手术节段、椎间盘退变情况(Pfirrmann分级法)、纤维环破裂与否、Lee分区情况、是否有Modic改变等资料进行统计,将上述因素作为因变量,进行单因素分析和多因素Logistic回归分析。结果 (1)疗效观察:100例患者均顺利完成手术,手术时间为46-70 min,平均65.1 min;出血量20-36 ml,平均28.5 ml。与术前相比,患者术后各时间段的VAS评分显著降低,JOA评分显著提高(P<0.05)。依据改良的Mac Nab疗效评定标准,优41例,良35例,可16例,差8例,总有效率为92%。(2)影响因素分析:将疗效优与良的患者作为疗效佳组,共76例;疗效可与差者作为疗效不佳组,共24例。单因素分析显示,患者年龄、病程、疼痛情况、椎间盘突出分级、有无外伤史等因素,均与疗效有显著性关系(P<0.05);多因素分析显示,其独立危险因素分别为:年龄≥45岁、病程在12个月以上、腰腿痛并重、椎间盘突出为Ⅳ级、有外伤史等。结论:经皮椎间孔镜技术治疗LDH,其创伤小、疗效可靠,可加以推广应用。但应注意的是,年龄≥45岁、病程在12个月以上、腰腿痛并重、椎间盘突出为Ⅳ级、有外伤史等因素,均可能对该手术的疗效造成影响。
Objective To observe the therapeutic effect of percutaneous endoscopic discectomy for lumbar disc herniation （LDH）. Methods A retrospective analysis was conducted in 100 patients with LDH who were treated with percutaneous endoscopic surgery from January 2013 to December 2014, the patients were followed up for 7-25 months after surgery. The preoperative and postoperative VAS, JOA scores and postoperative efficacy were evaluated. The curative effect was excellent, good as good curative effect group and the curative effect was fair, poor as poor curative effect group, which seemed as independent variables. The patients＂ age, gender, course of disease, history of trauma, clinical symptoms, surgical segment and intervertebral disc degeneration （Pfirrmann classification）, broken of fiber ring, Lee partition, Modic changes and other data were selected as the dependent variable. Logistic single factor analysis and multivariate regression analysis were conducted. Results （1） The curative effect： all the patients were successfully completed the operation, the operation time was 46-70 min （average 65.1 min）. The bleeding volume was 20-36 ml （average 28.5 ml）. Compared with preoperation, the VAS scores of patients after operation were significantly lower and the JOA score was significantly improved （P〈0.05）. According to the modified MacNab criteria, excellent in 41 cases, good in 35 cases, fair in16 cases and poor in 8 cases, the total effective rate was 92%. （2） Analysis of the influencing factors： the good curative effect group had 76 cases, the poor effect group had 24 cases. Single factor analysis showed that the age, duration, pain, grading, intervertebral disc herniation, history of trauma had significant correlation with the curative effect （P 〈0.05）. Multi-factor analysis showed that the independent risk factors were age over 45 years, in the course of 12 months, both in lumbocrural pain, intervertebral disc herniation with grade IV, with history of trauma etc. Conclusion P
出处
《颈腰痛杂志》
2017年第5期397-400,共4页
The Journal of Cervicodynia and Lumbodynia
关键词
腰椎间盘突出症
椎间孔镜
疗效观察
影响因素
lumbar disc herniation
intervertebral disc
observation of curative effect
influencing factors
