经皮内镜腰椎间盘切除术治疗经保守治疗无效的腰椎间盘突出症的临床效果

Clinical effect of percutaneous endoscopic lumbar discectomy in treatment of lumbar disc herniation after conservative treatment

摘要:

目的 分析经皮内镜腰椎间盘切除术（PELD）治疗经保守治疗无效的腰椎间盘突出症（LDH）的临床效果。方法 选取60例经保守治疗无效的LDH患者行PELD。比较患者治疗前后视觉模拟评分（VAS）、日本骨科协会（JOA）评分、改良Macnab优良率及并发症发生率等。结果 患者手术前后VAS比较，差异有统计学意义（F = 4.12，P < 0.05）；经两两比较，术后6和12个月VAS均低于术前（t = 4.27，t = 4.31，P < 0.05），且术后12个月的VAS低于术后6个月（t = 4.06，P < 0.05）；患者手术前后JOA评分比较，差异有统计学意义（F = 8.74，P < 0.05）；经两两比较，术后6和12个月JOA评分均高于术前（t = 5.89，t = 7.45，P < 0.05），且术后12个月的JOA评分高于术后6个月（t = 4.11，P < 0.05）；术后3个月，患者的改良Macnab优良率为90.00%，术后12个月优良率为93.34%，差异无统计学意义（χ² = 0.44，P > 0.05）；所有患者均顺利完成手术，且无复发；术后6个月并发症发生率为3.33%，术后12个月并发症发生率为5.00%，两者比较，差异无统计学意义（χ² = 0.21，P > 0.05）。结论 PELD用于保守治疗无效的LDH患者，能明显改善VAS和JOA评分，改良Macnab优良率较高，且术后并发症发生率较低，疗效显著，值得临床推广应用。

Abstract:

Objective To analyze the clinical effect of percutaneous endoscopic lumbar discectomy (PELD) in treatment of lumbar disc herniation (LDH) which is ineffective after conservative treatment.Methods 60 patients with LDH who failed to receive conservative treatment were all treated with PELD. The visual analogue scale (VAS), the Japanese Orthopaedic Association (JOA) score, the excellent and good rate of modified Macnab and the incidence of complications were compared before and after treatment.Results The VAS of patients before and after operation was significantly different (F = 4.12, P < 0.05); The VAS at 6 and 12 months after operation were lower than that before operation (t = 4.27, t = 4.31, P < 0.05), and the VAS at 12 months after operation was lower than that at 6 months after operation (t = 4.06, P < 0.05); The JOA scores of patients before and after operation were significantly different (F = 8.74, P < 0.05); The JOA score at 6 and 12 months after operation were higher than that before operation (t = 5.89, t = 7.45, P < 0.05), and the JOA score at 12 months after operation was higher than that at 6 months after operation (t = 4.11, P < 0.05). The excellent and good rate of modified Macnab was 90.00% at 3 months after operation, and 93.34% at 12 months after operation; The difference was not statistically significant (χ² = 0.44, P > 0.05). All patients successfully completed the operation without recurrence. The complication rate was 3.33% at 6 months after operation and 5.00% at 12 months after operation; There was no significant difference between them (χ² = 0.21, P > 0.05).Conclusion PELD can significantly improve VAS and JOA scores, in patients with ineffective LDH after conservative treatment. The improved Macnab has a high excellent rate, and a low postoperative complication rate and a significant effect, which is worthy of clinical promotion.