经皮椎间孔镜联合硬膜外注射治疗脱出型腰椎间盘突出症

目的:评价经皮椎间孔镜联合硬膜外注射治疗脱出型腰椎间盘突出症的疗效。方法 :对2014年3月至2015年6月接受经皮椎间孔镜下髓核摘除术的126例单节段脱出型腰椎间盘突出症患者进行前瞻性随机对照研究,男67例,女59例;年龄17~75岁,平均(41.0±13.5)岁;L3,49例,L4,576例,L5S141例。按随机数字表中随机数的奇数和偶数随机分为单纯椎间孔镜组和椎间孔镜联合硬膜外注射组,每组63例。单纯椎间孔镜组行经皮椎间孔镜下髓核摘除术后注入4 ml生理盐水,椎间孔镜联合硬膜外注射组行经皮椎间孔镜下髓核摘除术后注入1 ml复方倍他米松、1 ml利多卡因和2 ml甲钴胺。随访时间6~20个月,平均12.4个月,比较两组并发症情况,术后住院时间,恢复工作时间,疼痛视觉类比评分(visual analogue scale,VAS)和JOA评分,按改良Mac Nab标准评定临床疗效。结果:所有病例顺利完成手术,未见并发症。单纯椎间孔镜组术后住院时间和恢复工作时间分别(4.61±1.25)d、(4.31±0.47)周,椎间孔镜联合硬膜外注射组分别为(2.53±0.69)d、(3.14±0.52)周,两组差异有统计学意义(P=0.000)。两组术后VAS评分、JOA评分与术前比较,均明显改善(P=0.000)。椎间孔镜联合硬膜外注射组术后1 d、1周、1个月的VAS评分及JOA评分均优于单纯椎间孔镜组(P=0.000)。术后6个月两组VAS评分及JOA评分差异无统计学意义(P0.05)。术后按照改良Mac Nab标准评定疗效,单纯椎间孔镜组优39例,良21例,可3例;椎间孔镜联合硬膜外注射组优41例,良20例,可2例;两组差异无统计学意义(P=0.087)。结论 :经皮椎间孔镜治疗脱出型腰椎间盘突出症创伤小,疼痛缓解明显,功能恢复好。术中联合使用硬膜外注射短期内疼痛缓解及功能改善更加显著,可减少术后住院时间,早日恢复工作,是一种安全有效的手段。

Percutaneous endoscopic lumbar discectomy combined with epidural injection for prolapsed lumbar disc herniation

Objective: To assess the effect of percutaneous endoscopic lumbar discectomy (PELD) combined with epidural injection for prolapsed lumbar disc herniation(PLDH).Methods: In this prospective randomized controlled study,the clinical data of 126 patients who had undergone a PELD because of a single-level PLDH from March 2014 to June 2015 were analyzed. There were 67 males and 59 females,ranging in age from 17 to 75 years old with an average of(41.0±13.5) years old,9 cases were L_3,4,76 cases were L_4,5 and 41 cases were L₅S₁. According to the random number table,the patients were randomized into two groups,with 63 patients in each group. Patients in group 1 were injected normal saline after PLED,patients in group 2 were subjected to an epidural injection of Diprospan,Lidocaine and Mecobalamine after PLED. All the patients were followed up from 6 to 20 months with the mean of 12.4 months. Complications,the postoperative hospital stay,the period of return to work,visual analogue scale (VAS) and Japanese Orthopedic Association (JOA) score were compared between two groups,and clinical outcomes were evaluated according to modified MacNab criteria.Results: All the operations were successful,and no complications were found. The mean postoperative hospital stay and the period of return to work in group 1 were (4.61±1.25) days and (4.31±0.47) weeks,respectively,and in group 2 were (2.53±0.69) days and (3.14±0.52) weeks,there was significant differences between two groups(P=0.000). Postoperative VAS and JOA scores in two groups were obviously improved (P=0.000). At 1 day,1 week,1 month after operation,VAS,JOA scores in group 2 were better than that of group 1(P=0.000),and after 6 months,there was no significant difference between two groups(P>0.05). According to the modified MacNab criteria,39 cases got excellent results,21 good,3 fair in group 1,and which in group 2 were 41,20,2,respectively,there was no significant difference between two groups(P=0.087).Conclusion: PELD is an mini-invasive technique for PLDH,it can fleetly reduce pain and improve function. And combination with epidural injection has the advantages of pain releasing and function improving in the short-term postoperative period,and it can decrease postoperative hospital stay and time of returning to work,and it is a safe and effective method.