两种不同干预方式影响腰椎间盘摘除患者腰椎功能恢复比较

背景经皮激光椎间盘减压术和经皮自动腰椎间盘摘除术是近年来应用较多的腰椎间盘突出症的治疗方法.目的对比经皮激光椎间盘减压术和经皮自动腰椎间盘摘除术后患者症状和体征的改善情况,并分析两种术式的特征.设计同期非随机对照观察.单位解放军第四七四医院.对象选择解放军第四七四医院有不同程度腰腿痛病的住院患者106例作为观察对象,按照不同干预措施分为经皮自动腰椎间盘摘除术组(n=46)和经皮激光椎间盘减压术组(n=60).干预措施①经皮自动腰椎间盘摘除术组逐级插入扩张管留置4.8mm工作套管,用环锯在纤维环上"开窗",髓核钳夹取髓核约1～5 g;电动切吸器吸取髓核0.5～1.5g.术毕拔出电动切吸器和工作套管.②经皮激光椎间盘减压术组拔出针芯,插入光导纤维,其前端5mm裸露段正好超出针尖.用15 W激光烧灼,每持续1 s,间隔4 s,调整激光总输出功率1200～1700 J.术后患者仰卧,检查疼痛缓解情况和功能恢复情况.根据改良的Macnab标准进行疗效评估,结果用百分率表示.主要观察指标①治疗后两组患者功能恢复情况.②术式及其不良反应比较.结果①经皮自动腰椎间盘摘除术组术后恢复情况优22例(478%)、良18例(39.1%)、可5例(10.9%)、差1例(2.2%),优良率86.9%.②经皮激光椎间盘减压术组术后恢复情况优29例(48.4%)、良20例(333%)、可9例(15.0%)、差2例(3.3%),优良率81.7%.③两组优良率比较无明显差别(x2=0.704,P＞0.05).④不良反应两组患者术后下肢疼痛均缓解,腰部酸痛持续数天后逐渐缓解、消失.经皮自动腰椎间盘摘除术组出现1例椎间盘感染,经皮激光椎间盘减压术组无并发症发生.结论经皮自动腰椎间盘摘除术和经皮激光椎间盘减压术两种方法治疗腰椎间盘突出症,术后两组优良程度无明显差别.但两种干预方式比较,经皮自动腰椎间盘摘除术操作简便,损伤小,不易出现并发症.

Two differentintervention measures in recovery of lumbar function of patients who underwent lumbardiscectomy

BACKGROUND: Percutaneous laser disc decompression (PLDD) and automated peroutaneous lumbar discectomy (APLD) have been widely used in the treatment of lumbar intervertebral disc prolapse.OBJECTIVE: To compare the symptoms and improvements of patients after receiving PLDD and APLD and analyze the characteristics of the two operations.DESIGN: A non-randomized concurrent controlled observation.SETTING: The 474 Hospital of Chinese PLA.PARTICIPANTS: Totally 106 inpatients with lumbar and leg diseases of different extent were selected from the 474 Hospital of Chinese PLA as the subjects. The patients were divided into APLD group( n =46) and PLDD group( n = 60) according to different intervention measures.INTERVENTIONS: APLD group: The dilating tube was probed at different levels, and working cannula of 4.8 mm was retained at last. The fenestration was made at the fibrous rings with the trepan, then nucleus pulposus of about 1 - 5 g was clipped by the pliers for nucleus pulposus. Electric discectomy apparatus was used to aspirate the nucleus pulposus of about 0.5 - 1.5 g at 600 - 300 rounds per minute. The electric discectomy apparatus and working cannula were pulled out after operation. PLDD group: The stylet was removed and optical fibers were inserted with the naked front segment (5 mm) com pletely going beyond the needle end. Cautery was made with 15 W laser for 1 s once a time at the interval of 4 s. The total output power of laser was adjusted between 1 200 - 1 700 joules. The patients lay at supine position to be examined for pain relief and functional recovery, and then they were sent back to the ward with flatbed cart for bed rest of 3 days. Therapeutic effects were evaluated according to modified Macnab' s criteria. The curative effect was presented as percentage.operations.excellent(47.8% ), 18 good(39. 1% ), 5 passable (10.9%), and 1 poor APLD group, there were 29 cases of excellent(48.4% ), 20 good (33.3%), 9 passable (15.0%), and 2 poor(3.3% ), with 81.7% excellent the two groups. Pain in the lumbar part usually sustained for several days,then was relieved and disappeared gradually. One patient in APLD group had infection of intervertebral disc. No complications occurred in PLDD group.CONCLUSION: PLDD and APLD do not differ significantly in excellent and good rate of treating prolapse of lumbar intervertebral disc. Compared with APLD, PLDD is a more convenient and minimally invasive technique causing fewer complications.