中国临床康复
中國臨床康複
중국림상강복
CHINESE JOURNAL OF CLINICAL REHABILITATION
2005年
22期
268-269
,共2页
杨军%杜凡%赵冬青%郑叶滨%李建国%邵勇刚
楊軍%杜凡%趙鼕青%鄭葉濱%李建國%邵勇剛
양군%두범%조동청%정협빈%리건국%소용강
功能恢复%疼痛%椎间盘切除术,经皮%激光手术%放射学,介入性
功能恢複%疼痛%椎間盤切除術,經皮%激光手術%放射學,介入性
공능회복%동통%추간반절제술,경피%격광수술%방사학,개입성
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4.8 mm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0.5～1.5 g.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5 mm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1200～1 700 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(47 8%)、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(33 3%)、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.
揹景:經皮激光椎間盤減壓術和經皮自動腰椎間盤摘除術是近年來應用較多的腰椎間盤突齣癥的治療方法.目的:對比經皮激光椎間盤減壓術和經皮自動腰椎間盤摘除術後患者癥狀和體徵的改善情況,併分析兩種術式的特徵.設計:同期非隨機對照觀察.單位:解放軍第四七四醫院.對象:選擇解放軍第四七四醫院有不同程度腰腿痛病的住院患者106例作為觀察對象,按照不同榦預措施分為經皮自動腰椎間盤摘除術組(n=46)和經皮激光椎間盤減壓術組(n=60).榦預措施:①經皮自動腰椎間盤摘除術組:逐級插入擴張管留置4.8 mm工作套管,用環鋸在纖維環上"開窗",髓覈鉗夾取髓覈約1～5 g;電動切吸器吸取髓覈0.5～1.5 g.術畢拔齣電動切吸器和工作套管.②經皮激光椎間盤減壓術組:拔齣針芯,插入光導纖維,其前耑5 mm裸露段正好超齣針尖.用15 W激光燒灼,每持續1 s,間隔4 s,調整激光總輸齣功率1200～1 700 J.術後患者仰臥,檢查疼痛緩解情況和功能恢複情況.根據改良的Macnab標準進行療效評估,結果用百分率錶示.主要觀察指標:①治療後兩組患者功能恢複情況.②術式及其不良反應比較.結果:①經皮自動腰椎間盤摘除術組術後恢複情況:優22例(47 8%)、良18例(39.1%)、可5例(10.9%)、差1例(2.2%),優良率86.9%.②經皮激光椎間盤減壓術組術後恢複情況優29例(48.4%)、良20例(33 3%)、可9例(15.0%)、差2例(3.3%),優良率81.7%.③兩組優良率比較:無明顯差彆(x2=0.704,P＞0.05).④不良反應:兩組患者術後下肢疼痛均緩解,腰部痠痛持續數天後逐漸緩解、消失.經皮自動腰椎間盤摘除術組齣現1例椎間盤感染,經皮激光椎間盤減壓術組無併髮癥髮生.結論:經皮自動腰椎間盤摘除術和經皮激光椎間盤減壓術兩種方法治療腰椎間盤突齣癥,術後兩組優良程度無明顯差彆.但兩種榦預方式比較,經皮自動腰椎間盤摘除術操作簡便,損傷小,不易齣現併髮癥.
배경:경피격광추간반감압술화경피자동요추간반적제술시근년래응용교다적요추간반돌출증적치료방법.목적:대비경피격광추간반감압술화경피자동요추간반적제술후환자증상화체정적개선정황,병분석량충술식적특정.설계:동기비수궤대조관찰.단위:해방군제사칠사의원.대상:선택해방군제사칠사의원유불동정도요퇴통병적주원환자106례작위관찰대상,안조불동간예조시분위경피자동요추간반적제술조(n=46)화경피격광추간반감압술조(n=60).간예조시:①경피자동요추간반적제술조:축급삽입확장관류치4.8 mm공작투관,용배거재섬유배상"개창",수핵겸협취수핵약1～5 g;전동절흡기흡취수핵0.5～1.5 g.술필발출전동절흡기화공작투관.②경피격광추간반감압술조:발출침심,삽입광도섬유,기전단5 mm라로단정호초출침첨.용15 W격광소작,매지속1 s,간격4 s,조정격광총수출공솔1200～1 700 J.술후환자앙와,검사동통완해정황화공능회복정황.근거개량적Macnab표준진행료효평고,결과용백분솔표시.주요관찰지표:①치료후량조환자공능회복정황.②술식급기불량반응비교.결과:①경피자동요추간반적제술조술후회복정황:우22례(47 8%)、량18례(39.1%)、가5례(10.9%)、차1례(2.2%),우량솔86.9%.②경피격광추간반감압술조술후회복정황우29례(48.4%)、량20례(33 3%)、가9례(15.0%)、차2례(3.3%),우량솔81.7%.③량조우량솔비교:무명현차별(x2=0.704,P＞0.05).④불량반응:량조환자술후하지동통균완해,요부산통지속수천후축점완해、소실.경피자동요추간반적제술조출현1례추간반감염,경피격광추간반감압술조무병발증발생.결론:경피자동요추간반적제술화경피격광추간반감압술량충방법치료요추간반돌출증,술후량조우량정도무명현차별.단량충간예방식비교,경피자동요추간반적제술조작간편,손상소,불역출현병발증.
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.
