摘要
目的 比较不同入路椎间孔镜髓核摘除术治疗青少年腰椎间盘突出症(adolescent lumbar disc herniation,ALDH)的临床效果。方法 选取2019年1月至2021年1月在空军第九八六医院和空军军医大学唐都医院行椎间孔镜髓核摘除术治疗的82例ALDH患者,采用随机数字表法分为A、B两组,每组41例。A组采用经椎间孔侧后方入路,B组采用经后路椎板间入路。比较两组的手术情况、椎体稳定性、疼痛视觉模拟量表(visual analogue scale,VAS)评分和Oswestry功能障碍指数(Oswestry disability index,ODI)、临床疗效及术后并发症发生情况等。结果 B组的手术时间及住院时间均短于A组,术中出血量少于A组,差异有显著性(P<0.05)。两组术后1d、3个月、6个月的椎间隙高度、椎体间位移及椎间成角与术前相比差异均无显著性(P>0.05)。术后1d、3个月、6个月的腰腿痛VAS评分及ODI均明显低于术前,且B组明显低于A组,差异均有显著性(P<0.05)。A组的优良率(87.80%)和术后并发症发生率(4.88%)与B组(分别为92.68%和7.32%)比较差异均无显著性(P>0.05)。结论 经椎间孔侧后方入路与经后路椎板间入路椎间孔镜髓核摘除术治疗ALDH均可获得确切的临床效果,其中后路椎板间入路的术中出血量更少、手术时间更短、术后疼痛缓解更明显,更有利于术后恢复。
Objective To compare the clinical effects of different approaches of intervertebral foraminal endoscopic nucleus pulposus extraction in the treatment of adolescent lumbar disc herniation(ALDH).Method A total of 82 patients with ALDH who underwent transforaminal endoscopic nucleotomy in the 986th Hospital of the Air Force and Tangdu Hospital of the Air Force Military Medical University from January 2019 to January 2021 were selected.They were divided into two groups by random number table method(n=41):group A adopted the posterior approach through the intervertebral foramen,and group B adopted the posterior intervertebral plate approach.The operation effect,intraoperative bleeding,operation time,degree of pain and incidence of postoperative complications were compared between the two groups.Result Compared with group A,group B had shorter operation time,shorter hospital stay and less intraoperative bleeding(P<0.05).There were no significant changes in intervertebral space height,interbody displacement and intervertebral angle at 1 day,3 months and 6 months after operation(P>0.05),and there was no significant difference between the groups(P>0.05).The VAS scores of low back pain,VAS scores of leg pain and ODI scores of low back pain in the two groups were significantly lower than those before operation(P<0.05).The VAS score of low back pain,VAS score of leg pain and ODI score of low back pain in group B were lower than those in group A(P<0.05).There was no significant difference in the excellent and good treatment rate(87.80%vs 92.68%)and the total incidence of postoperative complications(4.88%vs 7.32%)between the two groups(P>0.05).Conclusion The treatment of ALDH by foraminal endoscopic nucleus pulposus extraction can obtain accurate results through the posterior foraminal approach and the posterior intervertebral plate approach.The posterior intervertebral disc approach has less intraoperative bleeding,shorter operation time and more obvious pain relief,which is more conducive to postoperative recovery.
作者
李东升
王蕊
魏延
赵海恩
Li Dongsheng;Wang Rui;Wei Yan;Zhao Haien(Air Force 986 Hospital,Shaanxi Xi’an 710025,China;Department of Orthopedics,Tangdu Hospital,Air Force Medical University,Shaanxi Xi’an 710038,China)
出处
《中国医刊》
CAS
2022年第5期523-526,共4页
Chinese Journal of Medicine
基金
国家自然科学基金(82174166)。
关键词
青少年
腰椎间盘突出症
椎间孔镜髓核摘除术
手术入路
腰椎功能
Adolescent
Lumbar disc herniation
Intervertebral foraminal endoscopic enucleation
Operative approach
Lumbar function
