中医正骨
中醫正骨
중의정골
THE JOURNAL OF TRADITIONAL CHINESE ORTHOPEDICS AND TRAUMATOLOGY
2014年
11期
9-11
,共3页
孙德舜%宋义博%李庆斌%张建新
孫德舜%宋義博%李慶斌%張建新
손덕순%송의박%리경빈%장건신
超声骨刀%椎间盘移位%腰椎%椎间盘切除术,经皮
超聲骨刀%椎間盤移位%腰椎%椎間盤切除術,經皮
초성골도%추간반이위%요추%추간반절제술,경피
Piezosurgery%Intervertebral disc displacement%Lumbar vertebrae%Surgical procedures,minimally invasive%Diskectomy,percutaneous
目的：探讨应用超声骨刀进行椎间孔镜下髓核摘除术治疗腰椎间盘突出症的临床疗效和安全性。方法：腰椎间盘突出症患者28例，随机分为2组，观察组12例，对照组16例。2组患者均采用椎间孔镜下髓核摘除术治疗，观察组术中应用超声骨刀，对照组术中不应用超声骨刀。观察2组患者手术时间、术中出血量、椎间孔成形时间及症状缓解、功能恢复和并发症发生情况。结果：观察组12例患者均顺利完成手术；对照组中3例患者因疼痛刺激未完成手术，经患者及家属同意后改行其他术式。观察组手术时间、术中出血量及椎间孔成形时间均少于对照组[（33.75±3.19）min，（53.88±2.73）min；t =17.954，p =0.001；（16.33±2.39）mL，（22.00±3.74）mL；t =4.582，p =0.020；（12.42±3.00）min，（30.06±4.39）min；t =11.964，p =0.002]。手术前后各时间点间 JOA 下腰痛评分比较，差异有统计学意义，存在时间效应（F =663.032，p =0.001）；2组间 JOA 下腰痛评分比较，差异有统计学意义，存在分组效应（F =14.154，p =0.001）；术前2组间 JOA 下腰痛评分比较，差异无统计学意义[（7.86±1.48）分，（7.94±1.24）分；t =0.638，p =0.610]；术后第1天、第3天、第7天、1个月及6个月，2组间 JOA 下腰痛评分比较，观察组均高于对照组[（12.38±1.98）分，（9.41±2.47）分，t =3.081，p =0.005；（15.81±2.40）分，（11.47±3.70）分，t =4.109，p =0.001；（20.32±3.75）分，（18.87±4.21）分，t =2.649，p =0.018；（26.50±4.12）分，（25.11±3.72）分，t =2.561，p =0.019；（28.41±7.53）分，（27.79±8.48）分，t =2.219，p =0.043]；时间因素与分组因素不存在交互效应（F =0.627，p =0.594）。2组患者均无神经根、硬膜囊损伤及椎间隙感染等并发症发生。结论：在椎间孔镜下髓核摘除术中应用超声骨刀，可明显缩短手术时间和椎间孔成形时间、减少术中出血量，更有利于症状缓解和腰椎功能恢复。
目的：探討應用超聲骨刀進行椎間孔鏡下髓覈摘除術治療腰椎間盤突齣癥的臨床療效和安全性。方法：腰椎間盤突齣癥患者28例，隨機分為2組，觀察組12例，對照組16例。2組患者均採用椎間孔鏡下髓覈摘除術治療，觀察組術中應用超聲骨刀，對照組術中不應用超聲骨刀。觀察2組患者手術時間、術中齣血量、椎間孔成形時間及癥狀緩解、功能恢複和併髮癥髮生情況。結果：觀察組12例患者均順利完成手術；對照組中3例患者因疼痛刺激未完成手術，經患者及傢屬同意後改行其他術式。觀察組手術時間、術中齣血量及椎間孔成形時間均少于對照組[（33.75±3.19）min，（53.88±2.73）min；t =17.954，p =0.001；（16.33±2.39）mL，（22.00±3.74）mL；t =4.582，p =0.020；（12.42±3.00）min，（30.06±4.39）min；t =11.964，p =0.002]。手術前後各時間點間 JOA 下腰痛評分比較，差異有統計學意義，存在時間效應（F =663.032，p =0.001）；2組間 JOA 下腰痛評分比較，差異有統計學意義，存在分組效應（F =14.154，p =0.001）；術前2組間 JOA 下腰痛評分比較，差異無統計學意義[（7.86±1.48）分，（7.94±1.24）分；t =0.638，p =0.610]；術後第1天、第3天、第7天、1箇月及6箇月，2組間 JOA 下腰痛評分比較，觀察組均高于對照組[（12.38±1.98）分，（9.41±2.47）分，t =3.081，p =0.005；（15.81±2.40）分，（11.47±3.70）分，t =4.109，p =0.001；（20.32±3.75）分，（18.87±4.21）分，t =2.649，p =0.018；（26.50±4.12）分，（25.11±3.72）分，t =2.561，p =0.019；（28.41±7.53）分，（27.79±8.48）分，t =2.219，p =0.043]；時間因素與分組因素不存在交互效應（F =0.627，p =0.594）。2組患者均無神經根、硬膜囊損傷及椎間隙感染等併髮癥髮生。結論：在椎間孔鏡下髓覈摘除術中應用超聲骨刀，可明顯縮短手術時間和椎間孔成形時間、減少術中齣血量，更有利于癥狀緩解和腰椎功能恢複。
목적：탐토응용초성골도진행추간공경하수핵적제술치료요추간반돌출증적림상료효화안전성。방법：요추간반돌출증환자28례，수궤분위2조，관찰조12례，대조조16례。2조환자균채용추간공경하수핵적제술치료，관찰조술중응용초성골도，대조조술중불응용초성골도。관찰2조환자수술시간、술중출혈량、추간공성형시간급증상완해、공능회복화병발증발생정황。결과：관찰조12례환자균순리완성수술；대조조중3례환자인동통자격미완성수술，경환자급가속동의후개행기타술식。관찰조수술시간、술중출혈량급추간공성형시간균소우대조조[（33.75±3.19）min，（53.88±2.73）min；t =17.954，p =0.001；（16.33±2.39）mL，（22.00±3.74）mL；t =4.582，p =0.020；（12.42±3.00）min，（30.06±4.39）min；t =11.964，p =0.002]。수술전후각시간점간 JOA 하요통평분비교，차이유통계학의의，존재시간효응（F =663.032，p =0.001）；2조간 JOA 하요통평분비교，차이유통계학의의，존재분조효응（F =14.154，p =0.001）；술전2조간 JOA 하요통평분비교，차이무통계학의의[（7.86±1.48）분，（7.94±1.24）분；t =0.638，p =0.610]；술후제1천、제3천、제7천、1개월급6개월，2조간 JOA 하요통평분비교，관찰조균고우대조조[（12.38±1.98）분，（9.41±2.47）분，t =3.081，p =0.005；（15.81±2.40）분，（11.47±3.70）분，t =4.109，p =0.001；（20.32±3.75）분，（18.87±4.21）분，t =2.649，p =0.018；（26.50±4.12）분，（25.11±3.72）분，t =2.561，p =0.019；（28.41±7.53）분，（27.79±8.48）분，t =2.219，p =0.043]；시간인소여분조인소불존재교호효응（F =0.627，p =0.594）。2조환자균무신경근、경막낭손상급추간극감염등병발증발생。결론：재추간공경하수핵적제술중응용초성골도，가명현축단수술시간화추간공성형시간、감소술중출혈량，경유리우증상완해화요추공능회복。
Objective:To study the clinical curative effects and safety of application of piezosurgery in transforaminal percutaneous en-doscopic discectomy in the treatment of lumbar disc herniation. Methods:Twenty-eight patients with lumbar disc herniation were randomly divided into observation group(12 cases)and control group(16 cases). The patients in the 2 groups were treated with transforaminal percu-taneous endoscopic discectomy,and the piezosurgery was used only in the observation group during the surgery. The operative time,blood loss,intervertebral foramen forming time,symptom relief,function restoration and complications were observed and compared between the two groups. Results:The surgery were performed successfully on the 12 patients in observation group,while the surgery were unfinished due to pain in 3 patients in control group and were changed for other operation after getting consent from the patients and their family. The oper-ative time,blood loss and intervertebral foramen forming time of the observation group were all less than those of the control group(33. 75 +/﹣ 3. 19 vs 53. 88 +/﹣ 2. 73 min;t = 17. 954,p = 0. 001;16. 33 +/﹣ 2. 39 vs 22. 00 +/﹣ 3. 74 ml;t = 4. 582,p = 0. 020;12. 42 +/﹣ 3. 00 vs 30. 06 +/﹣ 4. 39 min;t = 11. 964,p = 0. 002). There was statistical difference in Japanese orthopaedic association(JOA)scores between dif-ferent time points,in other words,there was time effect(F = 663. 032,p = 0. 001). There was statistical difference in JOA scores between the two groups,in other words,there was group effect(F = 14. 154,p = 0. 001). There was no statistical difference in preoperative JOA scores between the 2 groups(7. 86 +/﹣ 1. 48 vs 7. 94 +/﹣ 1. 24 points;t = 0. 638,p = 0. 610). The JOA scores of the observation group were all higher than those of the control group at 1,3,7 days and 1 and 6 months after the surgery(12. 38 +/﹣ 1. 98 vs 9. 41 +/﹣ 2. 47 points,t =3. 081,p = 0. 005;15. 81 +/﹣ 2. 40 vs 11. 47 +/﹣ 3. 70 points,t = 4. 109,p = 0. 001;20. 32 +/﹣ 3. 75 vs 18. 87 +/﹣ 4. 21 points,t = 2. 649, p = 0. 018;26. 50 +/﹣ 4. 12 vs 25. 11 +/﹣ 3. 72 points,t = 2. 561,p = 0. 019;28. 41 +/﹣ 7. 53 vs 27. 79 +/﹣ 8. 48 points,t = 2. 219,p =0. 043). There was interaction between time factor and group factor(F = 0. 627,p = 0. 594). No complications such as nerve root injury,du-ra injury and intervertebral space infection were found in the 2 groups. Conclusion:Application of piezosurgery can obviously shorten the operative time and the intervertebral foramen forming time and decrease intraoperative blood loss in transforaminal percutaneous endoscopic discectomy,,and it is more conducive to symptom relief and lumbar function recovery.
