【摘要】 目的探讨经皮椎间孔镜TESSY术治疗单纯型腰椎间盘突出症的临床疗效。方法将2012年6月—2016年7月收治的120例腰椎间盘突出症患者随机分为观察组和对照组各60例,观察组采用经皮椎间孔镜TESSY术,对照组采用传统开放手术,治疗后采用Mac Nab法评定两组患者的临床疗效,并测定两组患者VAS和ODI评分,腓总神经和胫后神经肌电图F波传导速度,以及两组患者的手术时间、手术切口大小、术中出血量、术后下地时间、平均住院时间,采用SPSS20.0软件对数据进行统计分析,计量资料比较采用t检验,计数资料采用χ2检验,以P<0.05为差异有统计学意义。结果治疗后,观察组总有效率98.33%,对照组总有效率75.00%,两组总有效率比较差异有统计学意义(χ2=14.135,P<0.05);观察组腓总神经和胫后神经肌电图F波传导速度分别为(48.78±4.73)m/s、(44.36±2.98)m/s,对照组观察组腓总神经和胫后神经肌电图F波传导速度分别为(39.57±4.19)m/s、(34.28±2.85)m/s,两组比较差异均有统计学意义(t=11.29 0、18.9 35,P<0.05);治疗后观察组疼痛视觉模拟评分(visual analogue scale,VAS)和功能障碍指数(oswestry disability index,ODI)评分分别为(1.85±0.43)分、(3.39±1.35)分,对照组分别为(10.12±0.64)分、(11.11±1.65)分。两组比较差异均有统计学意义(t=83.082、28.050,均P<0.05);观察组手术时间、手术切口大小、术中出血量、术后下地时间、平均住院时间分别为(53.29±14.33)min、(0.9±1.34)mm、(9.58±4.88)ml、(0.48±0.13)d、(2.21±1.16)d,对照组分别为(103.58±12.36)min、(65.47±12.31)mm、(109.63±11.31)ml、(6.56±2.39)d、(9.53±1.97)d,两组比较差异均有统计学意义(t=20.585、40.392、62.915、19.676、24.802,均P<0.05)。结论经皮椎间孔镜TESSY术可根本解除神经根压迫,有效缓解腰椎间盘突出症患者的临床症状,改善下肢神经功能,疗效优于传统开放手术治疗。更多还原

【Abstract】 Objective To explore the clinical effect of percutaneous lumbar intervertebral foramen TESSY in the treatment of simple lumbar disc herniation. Methods A total of 120 cases of lumbar disc herniation patients were randomly divided into observation group and control group. The observation group was treated with percutaneous interbody laminectomy(TESSY). The control group was treated with traditional open surgery. After treatment, the clinical efficacy of the two groups of patients was evaluated by Mac Nab method. The VAS and ODI scores of the two groups were measured. The defibrillation velocity of the common peroneal nerve and posterior tibial electromyography were measured. The operative time, the size of the incision, intraoperative blood loss, the time of postoperative and the average hospital stay of the two groups were compared. Data were analyzed by SPSS20.0 software. Measurement data were compared with t test and enumeration data with χ2 test. P<0.05 was considered statistically significant. Results After treatment, the total effective rate was 98.33% in the observation group and 75.00% in the control group. The total effective rate of the two groups was statistically significant(χ2=14.135, P<0.05). The velocity of F wave in the common peroneal and posterior tibial neurons in the observation group and the control group were [(48.78±4.73) m/s,(44.36±2.98) m/s], [(39.57±4.19),(34.28±2.85) m/s] respectively(t= 11.290, 18.935, P<0.05). After treatment, the scores of visual analogue scale(VAS) and oswestry disability index(ODI) of the observation group [(0.85±0.43),(3.39±1.35)] was significantly higher than that of the control group [(10.12±0.64),(11.11±1.65)], respectively. The difference between the two groups was statistically significant(t=83.082, 28.050, all P<0.05). In the observation group, the operative time, the size of the incision, intraoperative blood loss, the time of postoperative and the average hospital stay were [53.29±14.33(0.9±1.34) mm,(9.58±4.88)ml,(0.48±0.13) d,(2.21±1.16) d], and in the control group were[(103.58±12.36) min,(65.47±12.31) mm,(109.63±11.31)ml,(6.56±2.39) d,(9.53±1.97) d], respectively. There was significant difference between the two groups(t=20.585,40.392,62.915,19.676,24.802, all P<0.05). Conclusions Percutaneous transforaminal mirror TESSYS surgery can fundamental relieve nerve root compression, effectively alleviate the clinical symptoms of patients with lumbar disc herniation and improve lower limb nerve function. The effect is better than the traditional open surgery.更多还原