摘要
背景:经皮激光椎间盘减压术治疗腰椎间盘突出症是近年来国际上发展起来的一项新技术,但对其适应证的群组研究文献报道较少。目的:通过经皮激光椎间盘减压术治疗腰椎间盘突出症患者,探讨其适应证群组对术后缓解疼痛及改善腰椎功能的影响。设计:以患者为研究对象,非随机化同期对照研究。单位:解放军第四七四医院放射科。对象:1998-07/2002-08在解放军第四七四医院放射科做经皮激光椎间盘减压术,且随访超过1年的患者173例,男101例,女72例;年龄18～75岁。方法:将173例患者分为适应证良好组139例和适应证不良组34例。不良组又分为脱出组8例、椎管狭窄组15例和其他组11例,并根据VAS评分标准和改良的Macnab标准对其疗效进行评估。主要观察指标:主要结局:疼痛程度及腰椎功能。次要结局:①穿刺成功率。②不良事件和副反应。结果:L5～S1穿刺成功率96.3%,L3-4,L4-5穿刺成功率100%。适应证良好组,疼痛0级63例,疼痛1级51例,疼痛2级20例,疼痛3,4级5例,优良率为82.0%。适应证不良组优良率为55.9%,术后可出现腰部酸痛,一般持续数天逐渐缓解、消失,未发现椎间盘感染、腰大肌血肿、穿破肠管、神经根和血管损伤等并发症。与良好组比较差异有显著性意义(χ2=10.38,P<0.05)。结论:①经皮激光椎间盘减压术穿刺成功率高,疗效满?
BACKGROUND:Percutaneous laser disc decompression(PLDD) is a new technology dev eloped to treat lumbar herniated disk in recent years;however,only limited liter ature has been reported about cohort study on its indications. OBJECTIVE:To treat patients with lumbar disc herniations by PLDD and evaluate the effects of PLDD in releasing pain and improving lumbar function after operat ion. DESIGN:Non randomized concurrent controlled trial based on the patients. SETTING:Department of Radiology of the 474 Hospital of Chinese PLA. PARTICIPANTS:This study recruited totally 173 patients(101 males and 72 female s aged from 18 to 75 years) who received PLDD in the Department of Radiology of the 474 Hospital of Chinese PLA from July 1998 to August 2002 and were followed up for over one year. METHODS:The 173 patients were divided into good indication group(Group A,n=139 ) and poor indication group(Group B,n=34).Group B was further divided into extru sion group(Group B1 of 8 patients),lumbar canal stenosis group(Group B2 of 15 pa tients) and other conditions group(Group B3 of 11 patients).VAS scoring criteria and modified Macnab criteria were used to evaluate the curative effects. MAIN OUTCOME MEASURES:Primary results:the degree of pain and lumbar function. Secondary results:the success rate of puncture as well as adverse events and sid e effects. RESULTS:The success rate of puncture was 96.3%for performing through L5-S1 a nd 100%through L3 4 and L4 5.In Group A,excellent postoperative effects were seen in 63 cases,good in 51 cases,fair in 20 cases and poor in 5 cases,with 82.0 %excellent and good rates. The excellent and good rate in Group B was 55.9%.Po stoperative back pain could be relieved several days later.Other complications s uch as disc infection, psoas hematoma,rupture of colon, injuries of nerve roots and blood vessels did not occur.There was a significant difference between Group A and Group B(χ2 =10.38,P< 0.05). CONCLUSION:①PLDD is a convenient,safe and reliable procedure in treating lumb ar disc herniation because of its high success rate, satisfactory results and fe wer complications.②Proper selection of indications helps improve the curative e ffects of lumbar disc herniation.
出处
《中国临床康复》
CSCD
北大核心
2005年第14期202-203,共2页
Chinese Journal of Clinical Rehabilitation
