摘要
目的:比较椎间孔镜技术和靶点注射胶原酶髓核化学溶解术治疗极外侧型(Ⅱ型)腰椎间盘突出症的临床疗效。方法:62例极外侧Ⅱ型腰椎间盘突出症病人按入院先后顺序随机分为两组:A组采用靶点注射胶原酶髓核化学溶解术(n=30);B组采用椎间孔镜技术(n=32)。分别于术前、术后1天、1周、3个月、6个月采用疼痛视觉模拟评分法(visual analogue scale,VAS)评分和Oswestry功能障碍指数(Oswestry disability index,ODI)评价疼痛及功能障碍情况。末次随访时采用Macnab标准评价临床疗效,采用突出物明显缩小率评价术后影像学改变情况。结果:两组病人的疼痛均得到明显改善。两组病人在术后各时间点的VAS评分及ODI均显著低于相应的术前值,差异均有统计学意义(P<0.05);术后各时间点两组间比较,差异无统计学意义(P>0.05)。Macnab疗效评定发现术后6个月A组优良率90.0%,B组优良率93.8%,组间比较无显著性差异(P>0.05)。术后6个月两组突出物明显缩小率分别为93.3%和93.8%,组间比较无显著性差异(P>0.05)。结论:椎间孔镜技术和靶点注射胶原酶髓核化学溶解术均是治疗极外侧型(Ⅱ型)腰椎间盘突出症的有效方法,疗效无显著性差异。
Objective:To compare the clinical efficacy between percutaneous transforaminal endoscopic discectomy(PTED)and targeted injection of collagenase chemonucleolysis in treating far-lateral lumbar disc herniation(FLLDH).Methods:Sixty-two patients suffering from far-lateral lumbar disc herniation were divided into two groups:Patients in group A were treated with targeted injection collagenase chemonucleolysis(n=30),and group B with PTED(n=32).Visual analogue scale(VAS)and Oswestry disability index(ODI)were used to evaluate the analgesic effect before operation,1 day,1 week,3 months and 6 months after operation,respectively.Decreased degree of the herniation size was utilized to evaluate the change of image after 6 months via imaging examination.Results:The clinical pain symptoms of all patients were relieved obviously after operation.The VAS score and ODI of patients in group A and group B at each time point after operation were significantly lower than the corresponding preoperative values,and the difference was statistically significant(P<0.05);and there was no statistically significant difference between the two groups(P>0.05).At 6 months post-operation,the Macnab’s efficacy evaluation showed that the excellent and good rate of group A was 90.0%,and that of group B was 93.8%;and there was no statistically significant difference between the two groups(P>0.05).There was no significant difference in shrinkage ratio of herniation via imaging changes between the two groups(93.3%and 93.8%)6 months after operation.Conclusion:PTED technique and targeted injection of collagenase chemonucleolysis are both safe and effective in the treatment of far lateral lumbar disc herniations(typeⅡ),there was no significant difference on the clinical efficacy between the two procedures.
作者
赵家贵
张荣宜
朱本藩
赵龙
王立奎
ZHAO Jiagui;ZHANG Rongyi;ZHU Benfan;ZHAO Long;WANG Likui(Department of Pain Medicine,The First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)
出处
《中国疼痛医学杂志》
CAS
CSCD
北大核心
2023年第2期113-119,共7页
Chinese Journal of Pain Medicine
基金
安徽省自然科学基金(1808085MH310)。
