经皮经孔内镜椎间盘切除术后联合康复治疗对腰椎间盘突出症患者临床疗效影响

目的分析经皮经孔内镜椎间盘切除术(percutaneous endoscopic discectomy,PTED)术后联合康复治疗对腰椎间盘突出症(lumbar disc herniation,LDH)患者疼痛、机体功能、神经功能及生活质量的影响。方法本研究共纳入108例LDH患者,根据随机数字表法分为两组,其中54例术后给予康复治疗(观察组),54例给予常规功能锻炼(对照组)。术前,术后6周、3个月、6个月、12个月采用疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(oswestry disability index,ODI)、日本骨科协会(Japanese Orthopaedic association scores,JOA)评分、健康调查简表(the MOS item short from health survey,SF-36)评估两组患者疼痛程度、腰部功能变化情况、腰部神经功能变化情况和生活质量变化情况。术后12个月根据MacNab标准进行疗效评估。结果最终有效随访患者:观察组42例,对照组44例。观察组患者术后6周[(2.08±1.14)vs.(2.65±1.22)]、3个月[(1.41±1.02)vs.(1.84±1.01)]的VAS(下肢)均低于对照组患者(P<0.05);观察组患者术后6周[(3.18±1.04)vs.(3.71±1.02)]、3个月[(2.11±1.05)vs.(2.68±1.02)]的VAS(腰部)均低于对照组患者(P<0.05)。观察组患者术后6周[(16.99±2.77)vs.(18.07±2.14)]、3个月[(12.48±1.16)vs.(15.04±1.32)]、6个月[(9.58±1.19)vs.(11.35±1.15)]、12个月[(8.59±1.01)vs.(9.25±1.18)]的ODI均低于对照组患者(P<0.05);观察组患者术后6周[(17.28±1.47)vs.(15.65±1.32)]、3个月[(20.48±1.46)vs.(18.81±1.47)]、6个月[(22.76±1.17)vs.(21.05±1.05)]、12个月[(23.73±1.65)vs.(22.11±1.25)]的JOA均高于对照组患者(P<0.05)。SF-36方面,观察组患者术后6周[(18.12±4.88)vs.(16.68±5.45)]、术后3个月[(25.85±4.24)vs.(21.82±4.85)]、术后6个月[(35.47±5.67)vs.(30.25±5.48)]、术后12个月[(33.34±5.32)vs.(29.65±6.97)]的身体机能(physical functioning,PF)高于对照组患者(P<0.05);观察组患者术后12个月[(55.24±5.33)vs.(53.01±4.95)]的躯体角色(role physical,RP)高于对照组患者(P<0.05);观察组患者术后6周[(18.03±3.51)vs.(16.01±3.43)]、术后3个月[(23.55±4.41)vs.(20.16±4.14)]、术后6个月[(33.18±5.22)vs.(30.48±5.45)]、术后12个月[(46.32±5.71)vs.(41.16±5.53)]的躯体疼痛(bodily pain,BP)高于对照组患者(P<0.05);观察组患者术后6周[(51.92±3.42)vs.(50.05±3.56)]、术后3个月[(67.0±4.25)vs.(60.0±3.75)]、术后6个月[(69.05±5.48)vs.(64.05±5.22)]、术后12个月[(67.34±5.02)vs.(62.42±5.11)]的活力(vitality,V)高于对照组患者(P<0.05)。观察组患者MacNab疗效优良率高于对照组患者(92.7%vs.75.0%,χ~2=5.028,P=0.025)。结论PTED联合康复治疗优于单一的PTED,能缓解早期腰背部及腿痛,早期及远期改善机体功能及神经功能,改善生活质量。

Percutaneous endoscopic discectomy with postoperative rehabilitation in the treatment of lumbar disc herniation

Objective To investigate effects of percutaneous endoscopic discectomy(PTED)with postoperative rehabilitation on the body functions,neurological functions and quality of life in patients with lumbar disc herniation(LDH).Methods A total of 108 LDH patients were included in the study.All were divided into two groups according to the random number table:rehabilitation group(observation group,n=54);routine functional exercise group(control group,n=54).Visual analog scale(VAS),Oswestry disability index(ODI),Japanese Orthopaedic Association scores(JOA),MOS item short from health survey(SF-36)were used to compare the pain,lumbar functions,nerve functions and quality of life between the two groups preoperatively,6 weeks,3 months,6 months and 12 months postoperatively.MacNab was applied to evaluate treatment effects 12 months after the operation.Results Forty-two patients in the observation group and 44 patients in the control group were followed up.The lower extremity VAS scores of the observation group 6 weeks[(2.08±1.14)vs.(2.65±1.22)],3 months[(1.41±1.02)vs.(1.84±1.01)]postoperatively were lower than that of the control group(P<0.05).The lumbar VAS of the observation group 6 weeks[(3.18±1.04)vs.(3.71±1.02)],3 months[(2.11±1.05)vs.(2.68±1.02)]postoperatively were lower than that of the control group(P<0.05).The ODI of the observation group was lower than that of the control group 6 weeks[(16.99±2.77)vs.(18.07±2.14)],3 months[(12.48±1.16)vs.(15.04±1.32)],6 months[(9.58±1.19)vs.(11.35±1.15)],and 12 months[(8.59±1.01)vs.(9.25±1.18)]postoperatively(P<0.05).The JOA of the observation group was higher than that of the control group 6 weeks[(17.28±1.47)vs.(15.65±1.32)],3 months[(20.48±1.46)vs.(18.81±1.47)],6 months[(22.76±1.17)vs.(21.05±1.05)],and 12 months[(23.73±1.65)vs.(22.11±1.25)]postoperatively(P<0.05).The physical functioning(PF)of SF-36 of the observation group was higher than that of the control group 6 weeks[(18.12±4.88)vs.(16.68±5.45)],3 months[(25.85±4.24)vs.(21.82±4.85)],6 months[(35.47±5.67)vs.(30.25±5.48)],and 12 months[(33.34±5.32)vs.(29.65±6.97)]postoperatively(P<0.05);the role physical(RP)of SF-36 of the observation group was higher than that of the control group 12 months postoperatively[(55.24±5.33)vs.(53.01±4.95)](P<0.05);the bodily pain(BP)of SF-36 of the observation group was higher than that of the control group 6 weeks[(18.03±3.51)vs.(16.01±3.43)],3 months[(23.55±4.41)vs.(20.16±4.14)],6 months[(33.18±5.22)vs.(30.48±5.45)],and 12 months[(46.32±5.71)vs.(41.16±5.53)]postoperatively(P<0.05);the vitality(V)of SF-36 of the observation group was higher than that of the control group 6 weeks[(51.92±3.42)vs.(50.05±3.56)],3 months[(67.0±4.25)vs.(60.0±3.75)],6 months[(69.05±5.48)vs.(64.05±5.22)],and 12 months[(67.34±5.02)vs.(62.42±5.11)]postoperatively(P<0.05).MacNab:the excellent and good rate of the observation group was higher than that of the control group(92.7%vs.75.0%,χ~2=5.028,P=0.025).Conclusions Percutaneous endoscopic discectomy with postoperative rehabilitation can relieve the early back and leg pain,improve body functions,nerve functions,and quality of life in the treatment of lumbar disc herniation.