对比经皮椎间孔镜下髓核摘除术与微创经椎间孔腰椎椎体间融合术对腰椎间盘突出症患者的临床疗效
Comparison of the clinical efficacy of percutaneous transforaminal endoscopic discectomy and minimally invasive transforaminal lumbar interbody fusion in patients with lumbar disc herniation
杨奇峰 1谭洪宇 2张杨2
作者信息
- 1. 汝州市骨科医院脊柱科,河南 汝州 467599
- 2. 郑州大学第一附属医院骨科,河南 郑州 450000
- 折叠
摘要
目的:对比椎间孔镜下髓核摘除术(Percutaneous transforaminal endoscopic discectomy,PTED)和微创经椎间孔腰椎椎体间融合术(Minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)治疗腰椎间盘突出症(Lumbar disc herniation,LDH)患者的临床疗效.方法:收集汝州市骨科医院 2020年 6 月至 2023年 2 月收治的 92 例LDH患者,随机分为PTED组和MIS-TLIF组,各 46 例,分别行PTED术和MIS-TLIF术.术后 3 m,比较两组手术疗效和围术期指标;术后 1 d和术后 3 d,采用酶联免疫吸附法测定肿瘤坏死因子α(Tumor necrosis factor-α,TNF-α)、降钙素原(Procalcitonin,PCT)、C-反应蛋白(C-reactive protein,CRP)水平;术后 1 m和术后 3 m,采用疼痛数字量表(Numerical rating scale,NRS)评估疼痛程度,采用Oswestry功能障碍指数(Oswestry disability index,ODI)评估腰椎功能;术后随访 3 m,比较两组并发症发生情况.结果:术后 3 m,PTED组手术优良率高于MIS-TLIF组(P＜0.05);PTED组术中失血量少于MIS-TLIF组,切口长度、手术用时、术后初次下床活动时间、住院天数短于MIS-TLIF组(P＜0.05);术后 1 d、3 d,PTED组血清TNF-α、PCT、CRP水显低于MIS-TLIF组(P＜0.05);术后 1 m、3 m,PTED组ODI、NRS评分均低于MIS-TLIF组(P＜0.05);PTED组并发症发生率低于MIS-TLIF组(P＜0.05).结论:PTED术治疗LDH患者疗效更好,可优化围术期指标,减轻炎性反应和术后疼痛,减少并发症发生,改善腰椎功能.
Abstract
Objective:To compare the clinical efficacy of foraminal endoscopic nucleus pulposus extraction(PTED)and minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)in the treatment of patients with lumbar disc herniation(LDH).Methods:A total of 92 LDH patients admitted to Ruzhou Orthopedic Hospital from June 2020 to February 2023 were collected and randomly divided into the PTED group and MIS-TLIF group,with 46 cases in each group.PTED group underwent PTED and MIS-TLIF group underwent MIS-TLIF.After 3 months of surgery,the operative efficacy,and perioperative indexes were compared between the two groups.After 1 day and 3 days of surgery,the enzyme-linked immunosorbent assay was used to detect tumor necrosis factor-α(TNF-α),procalcitonin(PCT),and C-reactive protein(CRP)levels.After 1 month and after 3 months of surgery,a numerical rating scale(NRS)was used to evaluate the pain degree,Oswestry disability index(ODI)was used to evaluate the lumbar function.After 3 months of postoperative follow-up,the complications were compared between the two groups.Results:After 3 months of surgery,the excellent and good rate of operation in the PTED group was higher than that in the MIS-TLIF group(P<0.05).The intraoperative blood loss in the PTED group was less than that in the MIS-TLIF group,and the incision length,operation time,first postoperative activity time,and hospitalization days were shorter than those in the MIS-TLIF group(P<0.05).After 1 day and 3 days of surgery,the serum levels of TNF-α,PCT,and CRP in the PTED group were lower than those in the MIS-TLIF group(P<0.05).After 1 month and 3 months of surgery,ODI and NRS scores in the PTED group were lower than those in the MIS-TLIF group(P<0.05).The complication rate of the PTED group was lower than that of the MIS-TLIF group(P<0.05).Conclusion:PTED has a better effect on LDH patients,which can optimize perioperative indexes,reduce the inflammatory response and postoperative pain,reduce the occurrence of complications,and improve lumbar function.
关键词
腰椎间盘突出症/经皮椎间孔镜下髓核摘除术/微创经椎间孔腰椎椎体间融合术/腰椎功能/炎性因子Key words
lumbar disc herniation/Percutaneous transforaminal endoscopic discectomy/Minimally invasive transforaminal lumbar interbody fusion/Lumbar spine function/Inflammatory factor引用本文复制引用
出版年
2024
NETL
NSTL
万方数据