张铖,蒋海涛,戴健,唐晓明
ZHANG Cheng,JIANG Haitao,DAI Jian,TANG Xiaoming

• 1:南京医科大学附属淮安第一医院骨科

摘要(Abstract)：

目的:观察经皮椎间孔镜技术(TESSYS)对腰椎间盘突出症(LDH)的疗效、腰椎结构参数及运动功能的影响。方法:84例LDH患者分为对照组(n=39)和观察组(n=45),对照组患者行传统开窗减压手术,观察组患者行TESSYS术,比较2组患者手术时间、出血量、下床活动时间;采用视觉模拟评分(VAS)评估2组患者术前,术后第1天、3个月及12个月时的腰腿疼痛程度;于术前及术后12个月时,测量2组患者腰骶角、关节突关节角及腰椎曲度,采用腰椎功能障碍问卷(Roland-Morris)、Likert量表评分评估2组患者的运动功能,采用日本骨科协会治疗评估分数(JOA)和Oswestry功能障碍指数(ODI)评分评价腰椎功能;于术后3个月及术后12个月时,采用改良MacNab标准评估临床疗效。结果:观察组患者出血量、下床活动时间、住院时间、术后第1天腰痛VAS评分低于对照组(P <0. 05);术后12个月时,与治疗前比较,2组患者腰骶角角度降低、腰椎曲度增加、Roland-Morris评分降低、Likert评分升高,差异有统计学意义(P <0. 05); 2组患者术后12个月时的JOA评分高于术前、ODI指数低于术前(P <0. 05),优良率比较差异无统计学意义(P> 0. 05)。结论:TESSYS术治疗LDH的疗效优于传统开窗减压术式,术中出血量较少、临床症状缓解效果好、康复快,还能改善腰椎结构参数和运动功能。
Objective: To observe the curative effect of percutaneous transforaminal endoscopic spine system( TESSYS) on lumbar disc herniation( LDH) and its influence on lumbar vertebrae texture parameters and motor function. Methods: Eighty-four patients with LDH were divided into control( n = 39) and observation groups( n = 45). The control group accepted traditional fenestration decompression, while the observation group was given with TESSYS. Operative duration,intraoperative bleeding,postoperative ambulation time were compared between two groups. The visual analogue scale( VAS) was used to evaluate waist and leg pain degree before surgery,on 1 stday,at 3 rd months and 12 thmonths after surgery. The lumbosacral angle,zygapophyseal joint angle and lumbar curvature were measured before surgery and at 12 months after surgery. The Roland-Morris Disability Questionnaire( Roland-Morris) and Likert scale were used to evaluate motor function in the 2 groups.Additionally,the Japanese Orthopedic Association( JOA) score and Oswestry Dysfunction Index( ODI) were used to evaluate lumbar vertebral function. At 3 and 12 months after surgery,the modified MacNab standard was used to evaluate the clinical efficacy. Results: Intraoperative bleeding,postoperative ambulation time,postoperative hospital stays,and VAS score of low back pain on 1 st day after surgery were significantly lower in observation group than those of the control group( P < 0. 05).At 12 months after surgery, lumbosacral angles were decreased, while lumbar curvatures were increased. In addition,Roland-Morris scores were reduced,in contrast,Likert score increased( P <0. 05). At 12 months after surgery between two groups,JOA was increased,while ODI was decreased( P < 0. 05). The difference in excellent and good rates between two groups was not statistically significant( P > 0. 05). Conclusion: Compared with traditional fenestration decompression,TESSYS is more efficient in the treatment of LDH with less intraoperative bleeding,better clinical symptom relief,quicker recovery. Meanwhile,it can improve the lumbar vertebrae texture parameters and motor function.

关键词(KeyWords)： 椎间盘移位;经皮椎间孔镜技术;腰椎间盘突出症;腰椎结构参数;运动功能;视觉模拟评分
intervertebral disk displacement;transforaminal endoscopic spine system(TESSYS);lumbar disc herniation(LDH);lumbar vertebrae texture parameters;motor function;visual analogue scale(VAS)

Abstract:

Keywords:

基金项目(Foundation): 江苏省输血协会英科新创科研基金项目(JS20190028)

作者(Author): 张铖,蒋海涛,戴健,唐晓明
ZHANG Cheng,JIANG Haitao,DAI Jian,TANG Xiaoming

DOI: 10.19367/j.cnki.2096-8388.2020.12.021

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