本文選題：椎間孔鏡 + 顯微內(nèi)窺鏡��； 參考：《廣西中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:通過本隨訪比較經(jīng)皮椎間孔鏡下腰椎間盤切除術(shù)(percutaneous endoscopic lumbar discectomy,PELD)與后路顯微內(nèi)窺鏡下腰椎間盤切除術(shù)(microendoscopic discectomy,MED)治療腰椎間盤突出癥(lumbar disc herniation,LDH)的臨床指標(biāo),為臨床治療LDH方案選擇提供借鑒意義。方法:選取2014年10月至2016年08月60例確診為單節(jié)段腰椎間盤突出癥的收治住院患者,根據(jù)手術(shù)方式分為PELD組和MED組,通過記錄兩組病例患者體重指數(shù)、年齡因素、患者病程長(zhǎng)短、中醫(yī)證型、術(shù)后住院時(shí)間,術(shù)后按中醫(yī)證型給予患者口服院內(nèi)制劑膏方,術(shù)后采用視覺模擬量表(visual analogue scale,VAS)評(píng)分、JOA和Oswestry功能障礙指數(shù)(Oswestry disability index,ODI)進(jìn)行隨訪,所得結(jié)果進(jìn)行統(tǒng)計(jì)學(xué)分析評(píng)估療效。結(jié)果:隨訪到59例。MED組28例,PELD組31例。1.基本資料對(duì)比:經(jīng)單因素方差分析,兩組間患者年齡、體重指數(shù)和病程分布無差異無統(tǒng)計(jì)學(xué)意義(P0.05),提示兩組患者的年齡、體重指數(shù)及病程構(gòu)成比無明顯差異。兩組間性別構(gòu)成比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。2.兩組手術(shù)出血量、住院時(shí)間組間對(duì)比:住院時(shí)間、術(shù)中出血量組間對(duì)比差異有統(tǒng)計(jì)學(xué)意義(P0.05),提示PELD組在住院時(shí)間及術(shù)中出血量方面優(yōu)于MED組。3.MED組和PELD組組內(nèi)前后療效評(píng)分分別對(duì)比:兩組在手術(shù)前、手術(shù)后組內(nèi)比較顯示,根據(jù)腰椎JOA,VAS,ODI評(píng)分差異有統(tǒng)計(jì)學(xué)意義(P0.05),MED組和PELD組手術(shù)后癥狀及功能較術(shù)前均效果顯著,說明術(shù)后患者癥狀有明顯好轉(zhuǎn)。4.MED組與PELD組組間手術(shù)前后療效評(píng)分對(duì)比:組間比較顯示,兩組腰椎JOA,VAS,ODI評(píng)分組間對(duì)比評(píng)分無統(tǒng)計(jì)學(xué)意義(P0.05),兩組術(shù)后病人療效比較無明顯區(qū)別,MED組與PELD組在隨訪期間內(nèi)取得了相似的臨床療效,兩組比較手術(shù)后3天VAS評(píng)分有統(tǒng)計(jì)學(xué)意義(P0.05),差異有顯著性,說明PELD組術(shù)后患者疼痛癥狀3天內(nèi)明顯好于MED組。5.MED組與PELD組不同年齡段,體重指數(shù),中醫(yī)證型療效評(píng)分對(duì)比顯示:兩組腰椎JOA改善率,末次ODI評(píng)分組組間對(duì)比評(píng)分無統(tǒng)計(jì)學(xué)意義(P0.05),兩組術(shù)后病人療效比較無顯著差異,MED組與PELD組在不同年齡段,體重指數(shù),中醫(yī)證型療效差異研究中未體現(xiàn)療效差異。結(jié)論:1.本研究?jī)煞N治療措施PELD和MED均對(duì)治療腰椎間盤突出癥引起的腰腿痛均有效且效果相當(dāng),PELD和MED的療效差異還不能明確,只有嚴(yán)格把握適應(yīng)癥和突破學(xué)習(xí)曲線后熟練操作才能得到最佳療效。2.體現(xiàn)微創(chuàng)上PELD相比MED具有短期疼痛改善快,術(shù)中出血少,術(shù)后住院短,術(shù)后恢復(fù)快等優(yōu)勢(shì),對(duì)于腰椎穩(wěn)定性尚可的老年患者,PELD可取得滿意的療效。
[Abstract]:Objective: to compare the clinical indexes of percutaneous endoscopic lumbar discectomylotomy (endoscopic lumbar) and microendoscopic discectomy (endoscopic lumbar) in the treatment of lumbar intervertebral disc herniation (LIDH). To provide a reference for clinical treatment of LDH regimen selection. Methods: from October 2014 to August 2016, 60 inpatients with single segment lumbar disc herniation were selected and divided into PELD group and MED group according to the operation method. The body mass index and age factors of the two groups were recorded. The duration of the disease, the type of TCM syndromes, the duration of hospitalization after operation, and the oral preparation ointment were given to the patients according to the type of TCM syndromes. The visual analogue scale (VAS) score and the index of Oswestry dysfunction (Oswestry disability index ODI) were followed up after operation. The results were evaluated by statistical analysis. Results: a follow-up of 59 cases. MED group 28 cases of PELD group 31 cases. 1. Comparison of basic data: there was no significant difference in age, body mass index and course of disease distribution between the two groups by univariate ANOVA, indicating that there was no significant difference in age, body mass index and the proportion of course of disease between the two groups. There was no significant difference in sex composition between the two groups (P 0.05. 2). The amount of blood lost in operation and the length of hospitalization were compared between the two groups: length of stay, The difference of intraoperative bleeding volume was statistically significant (P 0.05), which suggested that PELD group was better than MED group in terms of hospitalization time and intraoperative bleeding volume. 3. The scores of curative effect before and after operation in MED group and PELD group were compared: the comparison between the two groups before and after operation showed that: 1. According to the difference in the scores of VAS-ODI of lumbar vertebrae, there was significant difference in the symptoms and functions after operation in P0.05 and PELD groups, which indicated that the symptoms of the patients after operation were obviously improved. 4. The scores of pre-and post-operation efficacy between MED group and PELD group were compared: the comparison between the two groups showed that the symptoms and functions of the two groups were significantly better than those of before and after operation. There was no significant difference in the scores between the two groups (P 0.05). There was no significant difference in the curative effect between the two groups. Similar clinical results were obtained between the MED group and the PELD group during the follow-up period. There was a significant difference in VAS scores between the two groups at 3 days after operation, which indicated that the pain symptoms in PELD group were significantly better than those in MED group and PELD group within 3 days, and the body mass index (BMI) was significantly better than that in MED group and PELD group. The scores of TCM syndromes showed that the improvement rate of lumbar JOA was not significant in the last ODI score group, and there was no significant difference in the curative effect between the two groups. There was no significant difference between the two groups in terms of age, body mass index (BMI), body mass index (BMI). The difference of curative effect was not reflected in the study of the difference of TCM syndromes. Conclusion 1. In this study, both PELD and MED were effective in the treatment of lumbago and leg pain caused by lumbar disc herniation. Only by mastering the indication and breaking through the learning curve can we get the best curative effect. 2. Compared with MED, minimally invasive PELD has the advantages of quick improvement of short-term pain, less intraoperative bleeding, short hospital stay and quick postoperative recovery. It can obtain satisfactory curative effect for elderly patients with stable lumbar vertebrae.
【學(xué)位授予單位】：廣西中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 趙芝婷;周建;;針灸治療腰椎間盤突出癥的療效觀察[J];陜西中醫(yī);2016年10期

2 李建江;楚戈;楊濤;黃異飛;吳彥生;劉巖路;;經(jīng)皮椎間孔鏡下TESSYS技術(shù)修復(fù)腰椎固定融合后鄰近節(jié)段退行性變[J];中國(guó)組織工程研究;2015年26期

3 趙錫武;韓康;劉鑫;孫煥科;榮輝;于興勝;劉通;趙廷寶;;經(jīng)皮椎間孔鏡與椎板開窗髓核摘除術(shù)治療腰椎間盤突出癥的臨床療效比較[J];現(xiàn)代生物醫(yī)學(xué)進(jìn)展;2015年14期

4 劉豐平;趙紅衛(wèi);陳海丹;羅茗刈;;后路顯微內(nèi)窺鏡下腰椎間盤髓核摘除術(shù)學(xué)習(xí)曲線及其影響因素[J];海南醫(yī)學(xué);2015年02期

5 白一冰;李嵩鵬;王力文;簡(jiǎn)偉;謝明玖;白榮天;;改良TESSYS技術(shù)治療腰椎神經(jīng)根管狹窄癥[J];頸腰痛雜志;2015年01期

6 菅新民;周建華;胡亞威;張弦;陳少初;;86例腰椎間盤突出癥相關(guān)危險(xiǎn)因素分析[J];醫(yī)學(xué)綜述;2014年15期

7 傅智軼;史建剛;賈連順;;有限椎板切除減壓與全椎板切除減壓內(nèi)固定術(shù)治療腰椎管狹窄癥的療效對(duì)比(英文)[J];中國(guó)矯形外科雜志;2014年15期

8 李邦偉;高宏;馬睿杰;陳煒吉;;經(jīng)皮穴位電刺激聯(lián)合溫針灸治療腰椎間盤突出癥療效評(píng)價(jià)[J];浙江中醫(yī)藥大學(xué)學(xué)報(bào);2014年07期

9 師紅波;;小切口椎板開窗髓核摘除術(shù)治療腰椎間盤突出癥臨床觀察[J];實(shí)用中西醫(yī)結(jié)合臨床;2014年05期

10 何升華;馬篤軍;王業(yè)廣;余偉吉;馮利剛;;經(jīng)皮椎間孔鏡下髓核摘除術(shù)治療青少年腰椎間盤突出癥[J];中醫(yī)正骨;2014年03期

，

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