摘要
目的比较不同术式治疗单节段腰椎间盘突出症患者的近期疗效及对腰椎动态的影响。方法收集2017年12月至2018年11月于五四一总医院骨科收治的单节段腰椎间盘突出症患者177例的临床资料进行回顾性分析,其中小开窗髓核摘除术+纤维环修复术(开放组)52例、椎板减压髓核摘除椎间融合内固定术(椎间融合组)41例、椎间盘镜下突出髓核摘除术+纤维环修复术(椎间盘镜组)46例、椎间孔镜下突出髓核摘除术神经根松解术(椎间孔镜组)38例,比较各组患者术后近期疗效与腰椎动态变化。结果各组患者治疗后近期疗效差异无统计学意义(U=3.060,P=0.382);开放组、椎间融合组、椎间盘镜组、椎间孔镜组患者术中出血量分别为(56.85±13.65)mL、(186.46±22.47)mL、(92.41±16.34)mL、(31.42±5.14)mL,差异有统计学意义(F=768.905,P=0.000);开放组、椎间融合组、椎间盘镜组、椎间孔镜组患者手术时间分别为(50.41±10.67)min、(132.84±20.69)min、(62.12±13.37)min、(83.46±15.98)min,差异有统计学意义(F=249.863,P=0.000);开放组、椎间融合组、椎间盘镜组、椎间孔镜组患者住院时间分别为(8.25±1.34)d、(10.52±1.37)d、(7.04±1.17)d、(4.26±0.86)d,差异有统计学意义(F=182.709,P=0.000);术后1个月、3个月时,椎间盘镜组与椎间孔镜组的疼痛视觉模拟量表(VAS)评分、功能障碍指数(ODI)评分均低于椎间融合组与开放组(均P<0.05),而椎间盘镜组与椎间孔镜组的腰痛评价量表(JOA)评分高于椎间融合组与开放组(均P<0.05)。结论四种不同术式均能有效治疗单节段腰椎间盘突出症,但椎间孔镜、椎间盘镜治疗能加快术后腰椎功能恢复。
Objective To compare the short-term curative effect of different surgical methods on patients with single-segment lumbar disc herniation(LDH)and influences on lumbar spine dynamics.Methods The clinical data of 177 patients with single-segment LDH who admitted in orthopedics department of the No.541 General Hospital from December 2017 to November 2018 were retrospectively analyzed.Among them,there were 52 cases underwent small open window discectomy and annulus fibrosis repair(open group),41 cases underwent decompressive laminectomy discectomy and intervertebral fusion internal fixation(intervertebral fusion group),46 cases underwent microendoscopic discectomy and annulus fibrosis repair(diskoscope group),and 38 cases underwent intervertebral foramen discectomy and neurolysis(intervertebral foramen group).The short-term curative effect and dynamic changes of lumbar spine after surgery were compared among all groups.Results There was no statistically significant difference in short-term curative effect among all groups after treatment(U=3.060,P=0.382).The intraoperative blood loss in the open group,intervertebral fusion group,diskoscope group and intervertebral foramen group were(56.85±13.65)mL,(186.46±22.47)mL,(92.41±16.34)mL and(31.42±5.14)mL,respectively,the difference was statistically significant(F=768.905,P=0.000).The operation time in the open group,intervertebral fusion group,diskoscope group and intervertebral foramen group was(50.41±10.67)min,(132.84±20.69)min,(62.12±13.37)min and(83.46±15.98)min,respectively,the difference was statistically significant(F=249.863,P=0.000).The average hospitalization time in the open group,intervertebral fusion group,diskoscope group and intervertebral foramen group was(8.25±1.34)d,(10.52±1.37)d,(7.04±1.17)d and(4.26±0.86)d,respectively,the difference was statistically significant(F=182.709,P=0.000).At 1 month and 3 months after surgery,the VAS scores and ODI scores in the diskoscope group and intervertebral foramen group were lower than those in the interverte
作者
张磊
Zhang Lei(Department of Orthopaedics,the No.541 General Hospital,Yuncheng,Shanxi 043800,China)
出处
《中国基层医药》
CAS
2020年第17期2082-2087,共6页
Chinese Journal of Primary Medicine and Pharmacy
关键词
椎间盘移位
腰椎
椎间盘切除术
经皮
失血
手术
住院时间
疼痛测定
疗效比较研究
Intervertebral disk displacement
Lumbar vertebrae
Diskectomy,percutaneous
Blood Loss,surgical
Length of stay
Pain measurement
Comparative effectiveness research
