经皮椎间孔镜与传统开窗手术治疗腰椎间盘突出症的疗效对比.doc

精品论文 参考文献 经皮椎间孔镜与传统开窗手术治疗腰椎间盘突出症的疗效对比 1湖南省浏阳市集里医院疼痛科 410300；2新乡医学院一附院骨科 453110 【摘 要】目的：评估经皮椎间孔镜下髓核摘除术及椎板开窗减压髓核摘除术两种术式治疗腰椎间盘突出的手术疗效，进一步总结经皮椎间孔镜治疗腰椎间盘突出症的临床应用价值以及手术操作技术要点。方法：收集本院腰椎间盘突出症病人，采用前瞻性随机对照研究，将病人随机分配至椎间孔镜组及椎板开窗组，统计患者术前术后VAS、ODI和手术相关指标及术后并发症，按改良Macnab标准评价临床疗效评估两种术式的手术疗效。结果：两组病人术前术后VAS、ODI评分相比差异有统计学意义（plt;0.01），手术相关指标（手术切口长度、失血量）相比差异有统计学意义（plt;0.05），椎间孔镜组及椎板开窗组术后优良率分别为83.3%和87.5%，两者相比差异无统计学意义。结论：两种手术方式均能有效缓解患者症状，与传统椎板开窗减压髓核摘除术相比，经皮椎间孔镜下髓核摘除术具有手术切口短，出血量少，手术时间短等优势；但也存在技术要求高，学习曲线陡峭等不足，在向基层医院临床推广中有一定的限制。 【关键词】经皮椎间孔镜髓核摘除术；椎板开窗髓核摘除术；腰椎间盘突出症 Abstract 【Objective】 To compare the clinical effects of percutaneous endocopic lumbar discectomy and fenestration discectomy for mono-segment lumbar disc herniation，providing a certain reference in clinical application for orthopedic surgeons. 【Methods】 A total of 48 cases of mono-segment lumbar disc herniation receiving surgery between Mar. 2015 and Mar.2016 were analyzed.Of which，24cases underwent PELD while 24 cases received FD by prospective random study.Counted the preoperative and postoperative Visual analogue scale（VAS），Oswestry disability index（ODI），and postoperative complications.Useing the improvement Macnab standard evaluate the clinical efficacy of two surgical procedures.【Result】 Two groups of patients all had smooth surgery. Both two groups was statistically significant（Plt;0.05）for VAS，ODI score preoperative to postoperative.The Macnab criteria excellent rate in six months was 83.3%，87.5%PTED and FD，respectively.where the differences were no statistically significant（Pgt;0.05）. 【Conclusion】 Both of PTED and FD can alleviate the symptoms of patients effectively. Compared with FD，PTED has advantages such as shorter incision，less bleeding and shorter operative time. However，there were shortcomes such as higher technical requirements，steep learning curve and so on，which limited the percutaneous transforaminal endoscopic discectomy popularizing in primary hospital. Key words：Percutaneous endocopic lumbar discectomy； F