椎间孔镜手术与等离子联合胶原酶手术治疗腰椎间盘突出症的临床疗效比较

赵龙; 张荣宜; 刘畅

doi:10.16766/j.cnki.issn.1674-4152.002177

椎间孔镜手术与等离子联合胶原酶手术治疗腰椎间盘突出症的临床疗效比较

doi: 10.16766/j.cnki.issn.1674-4152.002177

安徽医科大学第一附属医院疼痛科，安徽合肥 230022

基金项目:

安徽高校自然科学研究项目 KJ2018A0661

详细信息

通讯作者:
张荣宜，E-mail：rongyiz@126.com

中图分类号: R681.57 R687
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- 文章访问数: 152
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- 被引次数: 0
出版历程
- 收稿日期: 2021-02-24
- 网络出版日期: 2022-02-15

Comparison of the clinical effects of percutaneous transforaminal endoscopic discectomy and plasma-mediated radiofrequency ablation combined with collagenase in the treatment of lumbar disc herniation

Department of Pain Management, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China

摘要

摘要: 目的比较经皮椎间孔镜髓核摘除术与低温等离子联合胶原酶髓核消融术2种手术方法在腰椎间盘突出症治疗中的临床疗效。方法回顾分析安徽医科大学第一附属医院2018年1月—2020年1月收治的72例腰椎间盘突出症患者临床资料，根据患者接受的手术方式不同将患者分为经皮椎间孔镜髓核摘除术治疗组(A组)和低温等离子联合胶原酶髓核消融术治疗组(B组)，每组患者36例，比较分析A组和B组患者术后住院天数，术前、术后1周及术后1、3、6、12个月的疼痛视觉模拟评分(visual analogue scale, VAS)，采用改良的MacNab标准进行手术疗效评估。结果 A组和B组术后1周[A组(3.39±1.29)分, B组(4.00±1.62)分]、术后1个月[A组(2.19±0.86)分, B组(2.56±0.97)分]、术后3个月[A组(1.81±0.98)分, B组(2.25±1.00)分]、术后6个月[A组(1.36±0.64)分, B组(1.94±0.89)分]、术后12个月[A组(1.08±0.77)分, B组(1.69±0.79)分]与术前[A组(6.75±1.20)分, B组(7.00±1.17)分]相比，VAS评分均显著降低(均P < 0.05)。结论经皮椎间孔镜髓核摘除术与低温等离子联合胶原酶髓核消融术在腰椎间盘突出症的治疗中均可取得满意的近期疗效，能够显著缓解患者疼痛症状，改善患者生活质量，二者相比经皮椎间孔镜髓核摘除术远期效果更优。
- 腰椎间盘突出症 /
- 经皮椎间孔镜髓核摘除术 /
- 低温等离子联合胶原酶髓核消融术 /
- 疗效
Abstract: Objective To compare the clinical effect of percutaneous transforaminal endoscopic discectomy (PTED) and low-temperature plasma-mediated radiofrequency ablation combined with collagenase in the treatment of lumbar disc herniation (LDH). Methods Total 72 patients who were treated with LDH in the First Affiliated Hospital of Anhui Medical University from January 2018 to January 2020 were retrospectively analysed. The patients were divided into two groups: group A (36 patients treated with PTED) and group B (36 patients treated with low-temperature plasma-mediated radiofrequency ablation combined with collagenase). The postoperative hospital stay and visual analogue scale (VAS) score at different time points were compared between the two groups. The modified MacNab criteria were used to evaluate the clinical efficacy. Results Compared to preoperatively [A: (6.75±1.20) points, B: (7.00±1.17) points], the VAS score of both groups decreased significantly at 1 week [A: (3.39±1.29) points, B: (4.00±1.62) points], 1 month [A: (2.19±0.86) points, B: (2.56±0.97) points], 3 months [A: (1.81±0.98) points, B: (2.25±1.00) points], 6 months [A: (1.36±0.64) pointa, B: (1.94±0.89) points] and 12 months [A: (1.08±0.77), B: (1.69±0.79) points] after surgery (all P < 0.05). Conclusion PTED and low-temperature plasma-mediated radiofrequency ablation combined with collagenase could achieve satisfactory short-term effects in the treatment of LDH. Both surgical techniques could significantly alleviate the pain symptoms and improve the quality of life, whilst PTED could achieve better long-term effect.

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图 1 经皮椎间孔镜髓核摘除术工作通道正侧位透视图及术后神经根减压情况

注：*为L₄椎体，↗为神经根。

下载: 全尺寸图片幻灯片

图 2 低温等离子联合胶原酶髓核消融术穿刺路径及术后神经根减压情况

注：低温等离子联合胶原酶髓核消融术后硬膜囊周围分布气体，硬膜囊得到减压; ▲为硬膜囊。

下载: 全尺寸图片幻灯片

表 1 2组腰椎间盘突出症患者术前VAS评分、年龄、性别及术后住院时间比较

组别	例数	术前VAS评分(x±s，分)	年龄(x±s，岁)	性别[例(%)]		术后住院时间(x±s，d)
组别	例数	术前VAS评分(x±s，分)	年龄(x±s，岁)	男性	女性	术后住院时间(x±s，d)
A组	36	6.75±1.20	54.61±12.00	19(52.80)	17(47.20)	3.17±0.45
B组	36	7.00±1.17	56.72±12.39	22(61.10)	14(38.90)	3.11±0.32
统计量		0.893^a	0.720^a	0.510^b		0.652^a
P值		0.375	0.474	0.475		0.517
注：^a为t值，^b为χ²值。

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表 2 2组腰椎间盘突出症患者不同时间点VAS评分比较(x ±s，分)

组别	例数	术前	术后1周	术后1个月	术后3个月	术后6个月	术后12个月	F值	P值
A组	36	6.75±1.20	3.39±1.29^a	2.19±0.86^a	1.81±0.98^a	1.36±0.64^a	1.08±0.77^a	136.571	< 0.001
B组	36	7.00±1.17	4.00±1.62^a	2.56±0.97^a	2.25±1.00^a	1.94±0.89^a	1.69±0.79^a	111.127	< 0.001
t值		0.893	1.768	1.676	1.908	3.188	3.332
P值		0.375	0.081	0.098	0.061	0.002	0.001
注：与术前比较，^aP < 0.05。

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表 3 2组腰椎间盘突出症患者手术疗效优良率比较[例(%)]

组别	例数	术后6个月	术后12个月
A组	36	31(86.11)	34(94.44)
B组	36	23(63.89)	28(77.78)
χ²值		4.741	4.181
P值		0.030	0.041

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