经皮内镜腰神经根减压术后疼痛症状改善进展的研究

目的观察评估经皮脊柱内镜腰神经根减压术(PELD)术后腰腿疼痛症状的早期改善进展。 方法对解放军总医院2015年1月至2016年1月连续93例中84例PELD治疗腰背痛及神经根性疼痛症状的患者，前瞻性记录术后12周(各1周1次)的腰背痛视觉模拟评分(VAS)和下肢痛VAS，观察评估两种疼痛症状的改善进展并比较两者的改善度，用术后12周时腰背痛及下肢痛VAS、功能障碍指数评分(ODI)和改良MacNab疗效评定标准评价手术疗效。 结果腰背痛症状术后VAS评分相邻两周间比较，差异无统计学意义(P> 0.05)；下肢痛症状术后VAS评分的术后2周与术后1周比较(2.96 ± 1.97)分 vs (2.10 ± 1.29)分]、术后4周与术后3周比较(2.04 ± 1.62)分 vs (2.46 ± 1.97)分]，差异有统计学意义(P<0.05)；余下相邻两周间比较，差异无统计学意义(P > 0.05)；下肢痛术后12周VAS改善度与腰背痛VAS改善度比较(6.64 ± 1.47)分 vs (3.36 ± 1.38)分]，差异有统计学意义(P < 0.05)；术后12周时ODI、腰背痛VAS、下肢痛VAS均较术前显著降低(12.82 ± 6.39)分 vs (53.64 ± 11.73)分、(1.16 ± 1.06)分 vs (4.52 ± 0.65)分、(1.29 ± 1.30)分 vs (7.93 ± 0.81)分]，改良MacNab疗效评定标准评价优良率为86%。 结论PELD术后早期12周，腰背痛的症状改善平稳，下肢痛的症状改善在术后2周、术后3周出现波动，下肢痛症状比腰背痛症状改善更快，手术疗效显著。

The study of the early recovery in low back pain and leg pain after the percutaneous endoscopicsurgery

ObjectivesTo observe and assess the early recovery in low back pain and leg pain after the decompression of lumbar nerve root using percutaneous endoscopic lumbar discectomy (PELD). MethodsFrom Jan. 2015 to Jan. 2016, in 93 consecutive patients, 84 consecutive patients with low back pain and radicular pain were treated by using PELD. Visual analog score (VAS) of low back pain and leg pain were collected once a week, at consecutively postoperative 12 weeks , then compared the scores between adjacent two weeks separately. Outcome measures consisted of Oswestry Disability Index score (ODI) and VAS score of low back pain and leg pain between preoperative and postoperative, and modified MacNab criteria were compared. ResultsThere was no difference between the adjacent two weeks in postoperative low back pain VAS score (P> 0.05). The difference of postoperative leg pain VAS score between 2 weeks and 1 week (2.96 ± 1.97) vs (2.10 ± 1.29)], 4 weeks and 3 weeks (2.04 ± 1.62) vs (2.46 ± 1.97)], were significant (P< 0.05). There was no difference of postoperative leg pain VAS score between other adjacent 2 weeks (P> 0.05). The ODI score and VAS score of low back pain and leg pain at 12 weeks postoperative were lower significantly than at preoperative (12.82 ± 6.39) vs (53.64 ± 11.73), (1.16 ± 1.06) vs (4.52 ± 0.65), (1.29 ± 1.30) vs (7.93 ± 0.81)]. Based on the evaluation of the modified MacNab, excellent and good rate was 86%. ConclusionsThere was no obvious fluctuation in postoperative low back pain, and there were obvious fluctuations in postoperative leg pain at 2 weeks and 3 weeks. With 12 weeks follow-up, PELD had a better result in low back pain, leg pain and state of life.