摘要
【目的】探讨显微镜下椎间盘切除术(MSLD)和经皮椎间孔镜下腰椎间盘切除术(PELD)治疗腰椎间盘突出症的临床疗效。【方法】回顾性分析2013年12月至2022年5月在娄底市中心医院行微创手术治疗的486例腰椎间盘突出症患者的临床资料,其中行MSLD治疗的患者192例(MSLD组)和行PELD治疗的患者294例(PEID组),比较两组患者术前,术后1周、3个月、6个月、12个月以及末次随访(术后24个月)的疼痛视觉模拟评分(VAS)、徒手肌力检查(MMT)评分及相关并发症发生率。【结果】两组患者术后各个时间点VAS均显著低于术前(P<0.05);但两组治疗前后各个时间点VAS比较,差异无统计学意义(P>0.05)。两组患者术后各个时间点MMT评分均显著高于术前(P<0.05);但两组治疗前后各个时间点MMT评分比较,差异无统计学意义(P>0.05)。MSLD组总并发症发生率为2.60%(5/192),显著低于PELD组的8.50%(25/294),差异有统计学意义(P<0.05)。【结论】MSLD和PELD手术均可有效减轻腰椎间盘突出症患者疼痛,但PELD在局麻下操作,术中可检查患者的下肢肌力、疼痛与麻木的反馈,其警示作用可减少神经损伤,降低并发症发生率。
【Objective】To investigate the efficacy and safety of microsurgical lumbar discectomy(MSLD)and percutaneous endoscopic lumbar discectomy(PELD)in the treatment of lumbar disc herniation.【Methods】A total of 486 patients with lumbar disc herniation undergoing minimally invasive surgery at Loudi Central Hospital from December 2013 to May 2022 were retrospectively analyzed.Among them,192 patients underwent MSLD treatment(the MSLD group)and 294 patients underwent PELD(the PEID group).The pain visual simulation scores(visual analogue scale,VAS),the muscle strength score(manual muscle testing,MMT)at 1 week,3 months,6 months,12 months and 24 months after surgery and complication rates were compared between the two groups.【Results】The VAS scores of the two groups at each time point after surgery were significantly lower than those before surgery(P<0.05);however,there were no statistically significant differences in the VAS scores at each time point before and after treatment between the two groups(P>0.05).The MMT scores of the two groups of patients at each time point after surgery were significantly higher than those before surgery(P<0.05);however,there were no statistically significant differences in the MMT scores at each time point before and after treatment between the two groups(P>0.05).The total complication rate in the MSLD group was 2.60%(5/192),which was significantly lower than the 8.50%(25/294)in the PELD group,and the difference was statistically significant(P<0.05).【Conclusion】Both MSLD and PELD can effectively reduce the pain of patients with lumbar disc herniation.PELD is operated under local anesthesia,which can check the muscle strength of lower limbs,the feedback of pain and numbness during the operation.Its warning effect can reduce nerve damage and reduce the incidence of complications.
作者
陈涛
童新宙
郑阳
康忠山
康鹏程
陈良龙
CHEN Tao;TONG Xinzhou;ZHENG Yang(Department of Spinal Surgery,Loudi Central Hospital,Loudi Hunan 417000)
出处
《医学临床研究》
CAS
2024年第1期22-24,28,共4页
Journal of Clinical Research
基金
湖南省自然科学基金科卫联合基金(编号:2020JJ8028)。
