1.杭州市第九人民医院脊柱外科,浙江 杭州 311225
2.杭州市第九人民医院骨科,浙江 杭州 311225
LI Jian; E-mail: lijianhz_lj@163.com
纸质出版日期:2023-03-20,
收稿日期:2022-11-02,
扫 描 看 全 文
李坚,李锦锦,何丽萍.经皮椎间孔镜脊柱系统术治疗腰椎间盘突出症合并神经根管狭窄[J].中山大学学报(医学科学版),2023,44(02):342-347.
LI Jian,LI Jin-jin,HE Li-ping.Curative Effect of Percutaneous Transforaminal Endoscopic Spine System in the Treatment of Lumbar Disc Herniation Complicated with Nerve Root Canal Stenosis[J].Journal of Sun Yat-sen University(Medical Sciences),2023,44(02):342-347.
李坚,李锦锦,何丽萍.经皮椎间孔镜脊柱系统术治疗腰椎间盘突出症合并神经根管狭窄[J].中山大学学报(医学科学版),2023,44(02):342-347. DOI: 10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).2023.0220.
LI Jian,LI Jin-jin,HE Li-ping.Curative Effect of Percutaneous Transforaminal Endoscopic Spine System in the Treatment of Lumbar Disc Herniation Complicated with Nerve Root Canal Stenosis[J].Journal of Sun Yat-sen University(Medical Sciences),2023,44(02):342-347. DOI: 10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).2023.0220.
目的
2
探讨经皮椎间孔镜脊柱系统术(TESSYS)在腰椎间盘突出症(LDH)合并神经根管狭窄中的临床疗效。
方法
2
选取2019年4月至2021年4月我院收治的40例行TESSYS的LDH合并神经根管狭窄患者。于术后12个月通过改良腰椎Mac Nab疗效标准评价患者临床疗效,并于术前及术后6个月、12个月记录视觉模拟(VAS)评分、Oswestry功能障碍指数(ODI)评分及日本骨科协会(JOA)评分,于术前术后记录腰椎结构参数值及炎症因子水平。
结果
2
40例LDH合并神经根管狭窄患者均顺利完成手术及随访,术后12个月临床优良率为90%。术前、术后6个月及12个月,VAS评分为[(7.38±2.06)分、(2.36±0.87)分、(1.62±0.82)分],ODI评分为[(55.54±11.19)分、(26.52±7.61)分、(18.14±4.36)分],JOA评分为[(13.93±2.10)分、(20.26±1.35)分、(22.34±1.88)分],术后6个月及12个月VAS、ODI评分、JOA评分较术前明显改善(
P
<
0.05)。术前、术后,腰骶角角度为[(37.23±6.84)°、(27.37±4.31)°],腰椎曲度[(13.48±3.06)mm、(22.36±4.51)mm],术后腰骶角角度、腰椎曲度较术前明显改善(
P
<
0.05)。术前、术后,高敏C-反应蛋白(hs-CRP)为[(3.43±0.61)mg/L、(5.18±0.70)mg/L],肿瘤坏死因子(TNF-α)为[(1.44±0.27)mg/L、(2.07±0.44)mg/L],术后hs-CRP和TNF-α水平较术前明显升高(
P
<
0.05)。
结论
2
TESSYS治疗LDH合并神经根管狭窄具有较好的临床疗效,同时能够有效改善腰椎结构及功能,减轻腰椎疼痛程度,且术后伴有轻微的炎症反应。
Objective
2
To explore the clinical efficacy of percutaneous transforaminal endoscopic spine system (TESSYS) in the treatment of lumbar disc herniation (LDH) complicated with nerve root canal stenosis.
Methods
2
A retrospective study was done on 40 LDH patients complicated with nerve root canal stenosis who underwent TESSYS in our hospital from April 2019 to April 2021. The clinical efficacy of the patients was evaluated by the modified Mac Nab criteria 12 months after the surgery. We also measured and analyzed the scores of visual analogue scale (VAS), Oswestry disability index (ODI) and Japanese orthopaedic association (JOA), the changes of structural parameters of lumbar spine and inflammatory factor levels preoperatively, 6 and 12 months after the surgery.
Results
2
All the 40 cases successfully underwent the surgery and follow-ups, with a 12-month post-operative clinical excellent and good rate of 90%. The preoperative, 6-month and 12-month post-operative VAS scores were (7.38±2.06), (2.36±0.87) and (1.62±0.82), respectively. The respective ODI scores were (55.54±11.19), (26.52±7.61) and (18.14±4.36); JOA scores (13.93±2.10), (20.26±1.35) and (22.34±1.88). The post-operative scores of VAS, ODI and JOA were significantly improved compared with those before the surgery (
P
<
0.05). The preoperative and post-operative lumbosacral angles were (37.23±6.84)° and (27.37±4.31)°, respectively, with the respective lumbar curvatures of (13.48±3.06) mm and (22.36±4.51) mm. The post-operative lumbosacral angle and lumbar curvature were significantly improved compared with those before the surgery (
P
<
0.05). The preoperative and post-operative high-sensitivity C-reactive protein (hs-CRP) levels were (3.43±0.61) mg/L and (5.18±0.70) mg/L, respectively, with the respective tumor necrosis factor alpha (TNF-α) levels of (1.44±0.27) mg/L and (2.07±0.44) mg/L. The post-operative levels of hs-CRP and TNF-α were significantly higher than those before the surgery (
P
<
0.05).
Conclusion
2
In the treatment of LDH complicated with nerve root canal stenosis, TESSYS achieves a good clinical effect, improves the structure and function of the lumbar spine, reduces the degree of lumbar spine pain, and has a mild post-operative inflammatory reaction.
腰椎间盘突出症经皮椎间孔镜脊柱系统术腰椎功能炎症因子
lumbar disc herniation (LDH)percutaneous transforaminal endoscopic spine system (TESSYS)lumbar spine functioninflammatory factors
Zhou Y, Yang M. Clinical effect of the treatment of lumbar intervertebral disc protrusion[J]. Appl Bionics Biomech, 2022, 2022: 6803124.
陈锦旭, 邓德礼, 梁和胜. 经皮内镜椎间孔入路腰4/5与腰5/骶1腰椎间盘切除术学习曲线对比[J]. 中山大学学报(医学科学版), 2022, 43(5): 845-851.
Chen JX, Deng DL, Liang SH. Comparisons of the learning curve at the L4/5 and L5/S1 level for percutaneous endoscopic transforaminal discectomy[J]. J Sun Yat-sen Univ (Med Sci), 2022, 43(5): 845-851.
Wu PH, Kim HS, Jang IT. Intervertebral disc diseases part 2: a review of the current diagnostic and treatment strategies for intervertebral disc disease[J]. Int J Mol Sci, 2020, 21(6): 2135.
Rogerson A, Aidlen J, Jenis LG. Persistent radiculopathy after surgical treatment for lumbar disc herniation: causes and treatment options[J]. Int Orthop, 2019, 43(4): 969-973.
周忠良, 苏国宏, 郑保主, 等. 针刺推拿联合臭氧注射融盘术治疗腰椎间盘突出症的临床研究[J]. 中国中医骨伤科杂志, 2019, 27(5): 48-51.
Zhou ZL, Su GH, Zheng BZ, et al. Clinical study on the treatment of lumbar disc herniation by acupuncture massage combined with ozone injection[J]. Chin J Trad Med Traum & Orthop, 2019, 27(5): 48-51.
Yoo JS, Brundage TS, Hrynewycz NM, et al. Inpatient pain scores and narcotic utilization based on american society of anesthesiologists score following anterior cervical discectomy and fusion[J]. Spine, 2019, 44(22): 1558-1563.
Wallace P, Wallace LB, Tamura S, et al. Effectiveness of ultrasound guided platelet-rich plasma injections in relieving sacroiliac joint dysfunction[J]. Am J Phys Med Rehab, 2020, 99(8): 1.
Martin AR, Jentzsch T, Wilson JRF, et al. Inter-rater reliability of the modified japanese orthopedic association score in degenerative cervical myelopathy: a cross-sectional study[J]. Spine, 2021, 46(16): 1063-1069.
王李琴, 方景. 经皮椎间孔镜脊柱系统技术治疗腰椎间盘突出症合并神经根管狭窄的疗效观察[J]. 实用临床医药杂志, 2020, 24(20): 22-25.
Wang LQ, Fang J. Effect of percutaneous transforaminal endoscopic surgical system technique in the treatment of lumbar disc herniation combined with nerve root canal stenosis[J]. J Clin Med Pract, 2020, 24(20): 22-25.
张铖, 蒋海涛, 戴健, 等. TESSYS术对腰椎间盘突出症患者的疗效、腰椎结构参数及运动功能的影响[J]. 贵州医科大学学报, 2020, 45(12):1474-1478; +1483.
Zhang C, Jiang HT, Dai J, et al. Curative effect of TESSYS on patients with lumbar disc herniation and its influence on lumbar vertebrae texture parameters and motor function[J]. J Guizhou Med Univ, 2020, 45(12): 1474-1478; +1483.
唐劲, 向兴胜. 经皮椎间孔镜TESSYS技术治疗腰椎间盘突出症合并神经根管狭窄的疗效及对筋膜代偿能力的影响[J]. 颈腰痛杂志, 2019, 40(5): 663-666.
Tang J, Xiang XS. Effect of percutaneous foraminoscopy TESSYS technique on the treatment of lumbar disc herniation complicated with nerve root canal stenosis and its effect on fascial compensatory capacity[J]. J Cervic Lumb, 2019, 40(5): 663-666.
何传正, 向峰, 张银刚. 经皮椎间孔镜TESSYS技术治疗腰椎间盘突出症合并腰椎神经根管狭窄患者的疗效分析[J]. 中国药物与临床, 2021, 21(24): 4024-4026.
He CZ, Xiang F, Zhang YG. Effect analysis of TESSYS technique in the treatment of lumbar disc herniation with lumbar nerve root canal stenosis[J]. Chin Remed Clin, 2021, 21(24): 4024-4026.
邵楠, 张胜国, 邓茂松, 等. 经皮椎间孔镜TESSYS技术对腰椎间盘突出症患者应激反应及临床疗效的影响[J]. 颈腰痛杂志, 2018, 39(5): 672-673.
Shao N, Zhang SG, Deng MS, et al. Effect of percutaneous foraminoscopy TESSYS technique on stress response and clinical efficacy in patients with lumbar disc herniation[J]. J Cervic Lumb, 2018, 39(5): 672-673.
0
浏览量
1
下载量
0
CSCD
关联资源
相关文章
相关作者
相关机构