不同术式治疗腰椎间盘突出并腰椎管狭窄症疗效分析

目的分析椎间孔镜技术在治疗腰椎间盘突出并腰椎管狭窄症时与后路开放椎间盘融合术在疗效方面的差异.方法选择206例腰椎间盘突出并腰椎管狭窄症患者,随机分为观察组(行椎间孔镜技术)和对照组(行后路开放椎间盘融合术),每组103例.比较两组患者在围术期相关指标及术后不同时间点切口疼痛评分(VAS);比较两组患者在术后6个月时Oswestry功能障碍指数(ODI)和骨科协会评估治疗分数(JOA).结果观察组患者术中的出血量、手术所用时间及住院时间均少于对照组,差异具有统计学意义(P0.05);观察组与对照组患者术后切口的VAS评分与时间点(0.5,1,2 d)呈负相关,而观察组VAS评分下降趋势更明显,两组交互作用比较(组间、时点间、组间·时点间)差异具有统计学意义(P0.05);观察组患者术前、术后6个月的腰腿痛VAS评分分别与对照组比较差异无统计学意义(P0.05);两组患者术前腰腿疼VAS评分与各自术后比较,差异具有统计学意义(P0.05);观察组患者在术前、术后6个月的ODI评分及JOA评分与对照组比较,差异无统计学意义(P0.05);两组患者术前ODI评分和JOA评分与术后6个月评分比较差异具有统计学意义(P0.05).结论椎间孔镜技术能够取得与骨科开放手术基本一致的临床效果,且可减轻术中对患者的创伤程度,降低手术风险,提高患者恢复进度.

On Efficacy of Different Surgical Treatments for Lumbar Disc Herniation Combined with Lumbar Spinal Stenosis

Objective To analyze the difference in efficacy between transforaminal discectomy and open discectomy on the treatment of lumbar disc herniation combined with lumbar spinal stenosis.Method A total of 206 patients with lumbar disc herniation and lumbar spinal stenosis treated were selected. The patients were randomly divided into the observation group(transforaminal technique)and the control group(posterior open intervertebral disc fusion)with 103 patients in each group.The perioperative parameters and postoperative wound pain score at different time points(VAS)were compared between the two groups.And the Oswestry disability index(ODI)and Department of Orthopedics Association(JOA)evaluation score at the 6th month after the operation were also compared.Results Compared with the control group,the amount of bleeding,surgery time and hospitalization time of the observation group were all significantly less(P<0.05).The relationship between VAS score and time point(0.5,1,2 d)of the two groups were both negatively correlated,and the drop trend of VAS score in the observation group was more obvious. The interaction comparisons(inter-groups,inter-time point,inter-groups·inter-time point)showed statistically significant difference(P<0.05).No difference was found in the lower back pain VAS score before operation and at the 6th month after operation between the two groups(P>0.05).The difference in VAS score of each group before and after the operation was statistically significant(P<0.05).Compared with the control group,the ODI score and JOA score of the observation group before operation and at the 6th month after operation were not statistically significant(P>0. 05). The preoperative ODI score and JOA score of each group were both obviously different from the scores at the 6th month after operation(P<0.05).Conclusion The clinical effects of transforaminal endoscopic technique and open surgery are basically the same.The former technique can reduce the degree of trauma,the risk of surgery, and improve recovery progress,thus has higher application value in bone surgery and pain department.