经皮椎间孔镜髓核摘除术治疗腰椎间盘突出的临床效果(1)
[摘要]目的 评价经皮椎间孔镜髓核摘除术(PTED)治疗腰椎间盘突出症(LDH)的效果。方法 选取我院骨科2015年1月～2016年6月收治的42例LDH患者，随机分为对照组和观察组，每组21例。对照组行传统椎板开窗髓核摘除术治疗，观察组予以PTED治疗。比较两组的治疗效果。结果 观察组的切口长度、卧床时间及住院天数短于对照组，术中出血量少于对照组，差异有统计学意义(P<0.05)。观察组术后的VAS评分和ODI评分显著低于对照组，差异有统计学意义(P<0.05)。两组的Mac Nab优良率比较，差异无统计学意义(P>0.05)。结论 PTED治疗LDH创伤小，术中出血少，术后恢复快，并发症少，近期疗效可靠。
[关键词]腰椎间盘突出；经皮椎间孔镜髓核摘除术；临床效果
[中图分类号] R681.5 [文献标识码] A [文章编号] 1674-4721(2017)04(c)-0053-03
[Abstract]Objective To evaluate the efficacy of percutaneous endoscopic discectomy (PTED) in the treatment of lumbar disc herniation (LDH).Methods 42 patients with LDH in our hospital from January 2015 to June 2016 were selected and randomly divided into the control group and the observation group，21 cases in each group.The control group was given conventional fenestration discectomy，the observation group was treated with PTED.The therapeutic effects in the two groups were compared.Results The incision length，postoperative bed time，hospital stay in the observation group was shorter than that in the control group，intraoperative bleeding volume in the observation group was less than that in the control group，with significant difference (P<0.05).The score of VAS and ODI after operation in the observation group was lower than that in the control group，with significant difference (P<0.05).There was no significant difference between the two groups in the excellent and good rate of Mac Nab (P>0.05).Conclusion PTED in the treatment of LDH has little trauma，less bleeding，faster postoperative recovery，less complications， and reliable short-term efficacy.
[Key words]Lumbar disc herniation；Percutaneous discectomy；Clinical effect
目前临床治疗腰椎间盘突出症(lumbar disc heniation，LDH)多采用传统椎板开窗髓核摘除术，可有效解除神经压迫，缓解腰腿疼痛等症状，但也存在创伤大、组织结构破坏多、术后恢復时间长、易复发等问题[1-3]。经皮椎间孔镜髓核摘除术(percutaneous transforaminal endoscopic discectomy，PTED)是一种用于治疗腰椎疾病的微创术式，近年来逐渐在临床被接受和广泛应用[4-5]。本研究采用PTED治疗LDH，旨在为临床提供LDH的治疗依据和参考，现报道如下。
1资料与方法
1.1一般资料
选取2015年1月～2016年6月我院收治的42例LDH患者，年龄28～75岁，病程7个月～11年。将本组患者随机分为对照组和观察组，每组21例。对照组中，男13例，女8例；年龄(43.27±9.31)岁；病程(5.43±2.20)年；病变节段：L4～L5椎体9例，L5～S1椎体12例。观察组中，男12例，女9例；年龄(44.09±9.54)岁，病程(5.29±2.17)年；病变节段：L4～L5椎体8例，L5～S1椎体13例。两组的一般资料比较，差异无统计学意义(P>0.05)，具有可比性。纳入标准：①经问诊、体格检查、CT、X线等影像学检查符合LDH临床表现诊断标准[6]；②具有明确的手术适应证；③知情同意并积极配合本次研究。排除标准：①发生严重脊柱退变、脊柱不稳等非椎间盘病变引起的腰腿痛；②具有严重骨软化、骨质疏松等手术禁忌证；③移位位置较远的游离型LDH或中央型椎管狭窄伴严重钙化；④合并肝、肾及造血系统等原发疾病，感染性疾病等不能进行手术者，病损部位既往有手术治疗史以及未按规定行保守治疗。
1.2治疗方法
1.2.1术前准备 患者入院后行常规检查和影像学检查，术前常规备皮，并预防性给予抗生素。 (欧阳少明 饶放萍 刘辉)
[关键词]腰椎间盘突出；经皮椎间孔镜髓核摘除术；临床效果
[中图分类号] R681.5 [文献标识码] A [文章编号] 1674-4721(2017)04(c)-0053-03
[Abstract]Objective To evaluate the efficacy of percutaneous endoscopic discectomy (PTED) in the treatment of lumbar disc herniation (LDH).Methods 42 patients with LDH in our hospital from January 2015 to June 2016 were selected and randomly divided into the control group and the observation group，21 cases in each group.The control group was given conventional fenestration discectomy，the observation group was treated with PTED.The therapeutic effects in the two groups were compared.Results The incision length，postoperative bed time，hospital stay in the observation group was shorter than that in the control group，intraoperative bleeding volume in the observation group was less than that in the control group，with significant difference (P<0.05).The score of VAS and ODI after operation in the observation group was lower than that in the control group，with significant difference (P<0.05).There was no significant difference between the two groups in the excellent and good rate of Mac Nab (P>0.05).Conclusion PTED in the treatment of LDH has little trauma，less bleeding，faster postoperative recovery，less complications， and reliable short-term efficacy.
[Key words]Lumbar disc herniation；Percutaneous discectomy；Clinical effect
目前临床治疗腰椎间盘突出症(lumbar disc heniation，LDH)多采用传统椎板开窗髓核摘除术，可有效解除神经压迫，缓解腰腿疼痛等症状，但也存在创伤大、组织结构破坏多、术后恢復时间长、易复发等问题[1-3]。经皮椎间孔镜髓核摘除术(percutaneous transforaminal endoscopic discectomy，PTED)是一种用于治疗腰椎疾病的微创术式，近年来逐渐在临床被接受和广泛应用[4-5]。本研究采用PTED治疗LDH，旨在为临床提供LDH的治疗依据和参考，现报道如下。
1资料与方法
1.1一般资料
选取2015年1月～2016年6月我院收治的42例LDH患者，年龄28～75岁，病程7个月～11年。将本组患者随机分为对照组和观察组，每组21例。对照组中，男13例，女8例；年龄(43.27±9.31)岁；病程(5.43±2.20)年；病变节段：L4～L5椎体9例，L5～S1椎体12例。观察组中，男12例，女9例；年龄(44.09±9.54)岁，病程(5.29±2.17)年；病变节段：L4～L5椎体8例，L5～S1椎体13例。两组的一般资料比较，差异无统计学意义(P>0.05)，具有可比性。纳入标准：①经问诊、体格检查、CT、X线等影像学检查符合LDH临床表现诊断标准[6]；②具有明确的手术适应证；③知情同意并积极配合本次研究。排除标准：①发生严重脊柱退变、脊柱不稳等非椎间盘病变引起的腰腿痛；②具有严重骨软化、骨质疏松等手术禁忌证；③移位位置较远的游离型LDH或中央型椎管狭窄伴严重钙化；④合并肝、肾及造血系统等原发疾病，感染性疾病等不能进行手术者，病损部位既往有手术治疗史以及未按规定行保守治疗。
1.2治疗方法
1.2.1术前准备 患者入院后行常规检查和影像学检查，术前常规备皮，并预防性给予抗生素。 (欧阳少明 饶放萍 刘辉)