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
计量
- 文章访问数: 300
- HTML全文浏览量: 303
- PDF下载量: 7
- 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.

HTML全文

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。

下载: 导出CSV

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。

下载: 导出CSV

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

下载: 导出CSV

参考文献(21)

[1]	巩陈, 张涛, 胡伟, 等. 经椎间孔入路经皮内窥镜下椎间盘切除术治疗旁中央型腰椎椎间盘突出症[J]. 脊柱外科杂志, 2019, 17(2): 95-99. doi: 10.3969/j.issn.1672-2957.2019.02.005
[2]	王加旭, 邵水霖, 吴继功, 等. 经皮椎间孔镜椎间盘切除术治疗复发性腰椎间盘突出症的疗效[J]. 中国微创外科杂志, 2019, 19(3): 251-255. doi: 10.3969/j.issn.1009-6604.2019.03.015
[3]	唐云德, 徐卫国, 于风珍, 等. 椎间孔镜微创技术治疗老年腰椎间盘突出症的临床分析[J]. 临床外科杂志, 2019, 27(5): 439-442. doi: 10.3969/j.issn.1005-6483.2019.05.026
[4]	糜大国, 周斌, 卢炜, 等. 经皮椎间孔镜下腰椎管前方和侧方减压治疗腰椎管狭窄症的疗效观察[J]. 中华全科医学, 2019, 17(11): 1845-1848. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201911015.htm
[5]	梁海峰, 费琴明. 微创技术治疗腰椎管狭窄症的研究进展[J]. 中国临床医学, 2017, 24(2): 314-317. https://www.cnki.com.cn/Article/CJFDTOTAL-LCYX201702034.htm
[6]	赵波, 李召政, 朱良勇. 内窥镜腰椎间盘切除术对腰椎间盘突出症患者肢体功能及生活质量的影响[J]. 中国基层医药, 2017, 24(19): 2997-3001. doi: 10.3760/cma.j.issn.1008-6706.2017.19.030
[7]	杜明奎, 管大伟, 匡正达, 等. 经皮椎间孔镜技术治疗老年腰椎间盘突出症[J]. 中国骨与关节损伤杂志, 2018, 33(1): 58-59. https://www.cnki.com.cn/Article/CJFDTOTAL-GGJS201801020.htm
[8]	李欣艳. 腰椎间盘突出症的治疗进展[J]. 内蒙古中医药, 2018, 37(10): 113-115. doi: 10.3969/j.issn.1006-0979.2018.10.077
[9]	刘磊, 李业成, 刘守正, 等. 经皮椎间孔镜与椎板开窗髓核摘除术治疗腰椎间盘突出症的Meta分析[J]. 生物骨科材料与临床研究, 2019, 16(1): 21-27. doi: 10.3969/j.issn.1672-5972.2019.01.005
[10]	王立奎, 朱本藩, 赵家贵, 等. 低温等离子射频消融联合O₃及消炎镇痛液治疗包容性双节段腰椎间盘突出症的疗效分析[J]. 中国疼痛医学杂志, 2018, 24(6): 435-439. doi: 10.3969/j.issn.1006-9852.2018.06.008
[11]	吕工一, 赵合元. 经皮内窥镜外科技术治疗腰椎间盘突出症的研究进展[J]. 中国中西医结合外科杂志, 2018, 24(4): 526-529. doi: 10.3969/j.issn.1007-6948.2018.04.037
[12]	YILMAZ E, IKRIK IO LU H Y, BAYDUR H. The effect of functional disability and quality of life on decision to have surgery in patients with lumbar disc herniation[J]. Orthop Nurs, 2018, 37(4): 246-252. doi: 10.1097/NOR.0000000000000466
[13]	顾宇彤, 李云飞, 朱东晖, 等. 一种新的经皮椎间孔镜技术治疗腰椎术后椎间盘突出症的疗效分析[J]. 中国微创外科杂志, 2018, 18(5): 389-393. doi: 10.3969/j.issn.1009-6604.2018.05.002
[14]	EICHEN P M, ACHILLES N, KONIG V, et al. Nucleoplasty, a minimally invasive procedure for disc decompression: A systematic review and meta-analysis of published clinical studies[J]. Pain Physician, 2014, 17(2): E149-E173. http://www.researchgate.net/profile/Volker_Koenig/publication/261033586_Nucleoplasty_a_Minimally_Invasive_Procedure_for_Disc_Decompression_A_Systematic_Review_and_Meta-analysis_of_Published_Clinical_Studies/links/5645937a08ae54697fb889f6.pdf
[15]	王彦东, 马瑞, 钱济先, 等. 使用椎间孔镜治疗极外侧型腰椎间盘突出症的临床研究[J]. 中华全科医学, 2017, 15(7): 1099-1101, 1108. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201707003.htm
[16]	格日勒, 郭昭庆. 经皮椎间孔镜技术治疗腰椎间盘突出症的应用进展[J]. 中国微创外科杂志, 2018, 18(3): 267-270, 273. doi: 10.3969/j.issn.1009-6604.2018.03.019
[17]	AO S, WU J, ZHENG W, et al. A novel targeted foraminoplasty device improves the efficacy and safety of foraminoplasty in percutaneous endoscopic lumbar discectomy: Preliminary clinical application of 70 cases[J]. World Neurosurg, 2018, 115: e263-e271. doi: 10.1016/j.wneu.2018.04.032
[18]	谭林英, 徐峰. 经皮椎间孔镜术治疗腰椎间盘突出症合并后纵韧带骨化的疗效分析[J]. 中国临床神经外科杂志, 2018, 23(12): 788-791. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGLC201812008.htm
[19]	OH H S, HWANG B W, PARK S J, et al. Percutaneous endoscopic cervical discectomy (PECD): An analysis of outcome, causes of reoperation[J]. World Neurosurg, 2017, 102: 583-592. doi: 10.1016/j.wneu.2017.03.056
[20]	胡可君, 胡向阳, 欧阳红先. 经皮椎间孔镜治疗腰椎间盘突出症的临床疗效观察[J]. 中国实用医药杂志, 2019, 14(13): 62-64. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJXS201205034.htm
[21]	庄怀铭, 徐耿填, 黄青. 经皮椎间孔脊柱内窥镜治疗腰椎间盘突出症的疗效及安全性分析[J]. 中国微创外科杂志, 2019, 19(6): 506-508. doi: 10.3969/j.issn.1009-6604.2019.06.007