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[1]孫德舜,宋義博,李慶斌,等.超聲骨刀在椎間孔鏡下髓核摘除術(shù)中的應(yīng)用[J].中醫(yī)正骨,2014,26(11):9-11.
　Sun Deshu*,Song Yibo,Li Qingbin,et al.Application of piezosurgery in transforaminal percutaneous endoscopic discectomy[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2014,26(11):9-11.
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超聲骨刀在椎間孔鏡下髓核摘除術(shù)中的應(yīng)用()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第26卷
期數(shù):
2014年11期
頁碼:
9-11
欄目:
臨床研究
出版日期:
2014-11-30

文章信息/Info

Title:
Application of piezosurgery in transforaminal percutaneous endoscopic discectomy
作者:
孫德舜; 宋義博; 李慶斌; 張建新
山東省章丘市中醫(yī)醫(yī)院,山東 章丘 250200
Author(s):
Sun Deshu*; Song Yibo; Li Qingbin; Zhang Jianxin.*
Zhangqiu Hospital of Traditional Chinese Medicine,Zhangqiu 250200,Shandong,China
關(guān)鍵詞:
超聲骨刀 椎間盤移位 腰椎 椎間盤切除術(shù); 經(jīng)皮
Keywords:
Piezosurgery;  Intervertebral disc displacement;  Lumbar vertebrae;  Surgical procedures; minimally invasive;  Diskectomy; percutaneous
摘要:
目的:探討應(yīng)用超聲骨刀進(jìn)行椎間孔鏡下髓核摘除術(shù)治療腰椎間盤突出癥的臨床療效和安全性。方法:腰椎間盤突出癥患 者28例,隨機分為2組,觀察組12例,對照組16例。2組患者均采用椎間孔鏡下髓核摘除術(shù)治療,觀察組術(shù)中應(yīng)用超聲骨刀,對照組術(shù) 中不應(yīng)用超聲骨刀。觀察2組患者手術(shù)時間、術(shù)中出血量、椎間孔成形時間及癥狀緩解、功能恢復(fù)和并發(fā)癥發(fā)生情況。結(jié)果:觀 察組12例患者均順利完成手術(shù); 對照組中3例患者因疼痛刺激未完成手術(shù),經(jīng)患者及家屬同意后改行其他術(shù)式。觀察組手術(shù)時間 、術(shù)中出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(shù)前后各時間點間JOA下腰痛評分比較,差異有統(tǒng)計學(xué)意義,存在時間效應(yīng)(F=663.032,P=0.001); 2組間 JOA下腰痛評分比較,差異有統(tǒng)計學(xué)意義,存在分組效應(yīng)(F=14.154,P=0.001); 術(shù)前2組間JOA下腰痛評分比較,差異無統(tǒng)計學(xué)意義 [(7.86±1.48)分,(7.94±1.24)分; t=0.638,P=0.610]; 術(shù)后第1天、第3天、第7天、1個月及6個月,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(yīng)(F=0.627,P=0.594)。2組患者均無神經(jīng)根、硬膜囊損傷及椎間隙感染等并發(fā)癥發(fā)生。結(jié)論:在椎間孔鏡下髓核 摘除術(shù)中應(yīng)用超聲骨刀,可明顯縮短手術(shù)時間和椎間孔成形時間、減少術(shù)中出血量,更有利于癥狀緩解和腰椎功能恢復(fù)。
Abstract:
Objective:To study the clinical curative effects and safety of application of piezosurgery in transforaminal percutaneous endoscopic 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 percutaneous 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 operative 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 different 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,dura 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.

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更新日期/Last Update: 2014-11-30