CAJ | 학술논문

背景:经皮激光椎间盘减压术治疗腰椎间盘突出症是近年来国际上发展起来的一项新技术,但对其适应证的群组研究文献报道较少.目的:通过经皮激光椎间盘减压术治疗腰椎间盘突出症患者,探讨其适应证群组对术后缓解疼痛及改善腰椎功能的影响.设计:以患者为研究对象,非随机化同期对照研究.单位:解放军第四七四医院放射科.对象:1998-07/2002-08在解放军第四七四医院放射科做经皮激光椎间盘减压术,且随访超过1年的患者173例,男101例,女72例;年龄18～75岁.方法:将173例患者分为适应证良好组139例和适应证不良组34例.不良组又分为脱出组8例、椎管狭窄组15例和其他组11例,并根据VAS评分标准和改良的Macnab标准对其疗效进行评估.主要观察指标:主要结局:疼痛程度及腰椎功能.次要结局:①穿刺成功率.②不良事件和副反应.结果:L5～S1穿刺成功率96.3％,L3-L4,L4-L5穿刺成功率100％.适应证良好组,疼痛0级63例,疼痛1级51例,疼痛2级20例,疼痛3,4级5例,优良率为82.0％.适应证不良组优良率为55.9％,术后可出现腰部酸痛,一般持续数天逐渐缓解、消失,未发现椎间盘感染、腰大肌血肿、穿破肠管、神经根和血管损伤等并发症.与良好组比较差异有显著性意义(x2=10.38,P＜0.05).结论:①经皮激光椎间盘减压术穿刺成功率高,疗效满意,术后反应较轻,无明显并发症,是一种便利、安全、可靠的治疗腰椎间盘突出症的方法.②适当地选择适应证能够有效地提高腰椎间盘突出症治疗效果.
배경:경피격광추간반감압술치료요추간반돌출증시근년래국제상발전기래적일항신기술,단대기괄응증적군조연구문헌보도교소.목적:통과경피격광추간반감압술치료요추간반돌출증환자,탐토기괄응증군조대술후완해동통급개선요추공능적영향.설계:이환자위연구대상,비수궤화동기대조연구.단위:해방군제사칠사의원방사과.대상:1998-07/2002-08재해방군제사칠사의원방사과주경피격광추간반감압술,차수방초과1년적환자173례,남101례,녀72례;년령18～75세.방법:장173례환자분위괄응증량호조139례화괄응증불량조34례.불량조우분위탈출조8례、추관협착조15례화기타조11례,병근거VAS평분표준화개량적Macnab표준대기료효진행평고.주요관찰지표:주요결국:동통정도급요추공능.차요결국:①천자성공솔.②불량사건화부반응.결과:L5～S1천자성공솔96.3％,L3-L4,L4-L5천자성공솔100％.괄응증량호조,동통0급63례,동통1급51례,동통2급20례,동통3,4급5례,우량솔위82.0％.괄응증불량조우량솔위55.9％,술후가출현요부산통,일반지속수천축점완해、소실,미발현추간반감염、요대기혈종、천파장관、신경근화혈관손상등병발증.여량호조비교차이유현저성의의(x2=10.38,P＜0.05).결론:①경피격광추간반감압술천자성공솔고,료효만의,술후반응교경,무명현병발증,시일충편리、안전、가고적치료요추간반돌출증적방법.②괄당지선택괄응증능구유효지제고요추간반돌출증치료효과.
BACKGROUND: Percutaneous laser disc decompression(PLDD) is a new technology developed to treat lumbar herniated disk inrecent years; however,only limited literature has been reported about cohort study on its indications.OBJECTIVE: To treat patients with lumbar disc herniations by PLDD and evaluate the effects of PLDD in releasing painandimproving lumbar function after operation.DESIGN: Non-randomized concurrent controlled trial based on thepatients.SETTING: Department of Radiology of the 474 Hospital of Chinese PLA.PTICIPANTS: This study recruited totally 173 patients ( 101 males and 72 females aged from 18 to 75 years) who received PLDD in the Department of Radiology of the 474 Hospital of Chinese PLA from July 1998 to August 2002 and were followed up for over one year.METHODS: The 173 patients were divided into good indication group (Group A, n = 139) and poor indication group(Group B, n =34). Group B was further divided into extrusion group(Group B1 of 8 patients), lumbar canal stenosis group(Group B2 of 15 patients) and other conditions group (Group B3 of 11 patients). VAS scoring criteria and modified Macnab criteria were used to evaluate the curative effects.MAIN OUTCOME MEASURES: Primary results: the degree of pain and lumbar function. Secondary results: the success rate of puncture as well as adverse events and side effects.RESULTS: The success rate of puncture was 96. 3％ for performing through L5 - S1 and 100％ through L3-4 and L4-5. In Group A, excellent postoperative effects were seen in 63 cases, good in 51 cases, fair in 20 cases and poor in 5 cases, with 82.0％ excellent and good rates. The excellent and good rate in Group B was 55.9％. Postoperative back pain could be relieved several days later. Other complications such as disc infection, psoas hematoma,rupture of colon, injuries of nerve roots and bloodvessels did not occur. There was a significant difference between Group A and Group B(x2=10.38, P ＜0.05).CONCLUSION: (① PLDD is a convenient, safe and reliable procedure in treating lumbar disc herniation because of its high success rate, satisfactory results and fewer complications. ② Proper selection of indications helps improve the curative effects of lumbar disc herniation.