| 椎间孔镜下髓核摘除术和靶点射频热凝术治疗包容型腰椎间盘突出症的疗效比较 |
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投稿时间：2022-04-08
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| 作者 | Author | 单位 | Address | E-Mail |
| 霍路遥 |
HUO Lu-yao |
天津中医药大学第一附属医院 国家中医针灸临床医学研究中心 国家中医药管理局区域中医骨伤科诊疗中心, 天津 300192 |
The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Regional TCM Orthopedic Treatment Center of State Administration of Traditional Chinese Medicine, Tianjin 300192, China |
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| 于大伟 |
YU Da-wei |
天津中医药大学第一附属医院 国家中医针灸临床医学研究中心 国家中医药管理局区域中医骨伤科诊疗中心, 天津 300192 |
The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Regional TCM Orthopedic Treatment Center of State Administration of Traditional Chinese Medicine, Tianjin 300192, China |
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| 冯天笑 |
FENG Tian-xiao |
天津中医药大学第一附属医院 国家中医针灸临床医学研究中心 国家中医药管理局区域中医骨伤科诊疗中心, 天津 300192 |
The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Regional TCM Orthopedic Treatment Center of State Administration of Traditional Chinese Medicine, Tianjin 300192, China |
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| 符碧峰 |
FU Bi-feng |
天津中医药大学第一附属医院 国家中医针灸临床医学研究中心 国家中医药管理局区域中医骨伤科诊疗中心, 天津 300192 |
The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Regional TCM Orthopedic Treatment Center of State Administration of Traditional Chinese Medicine, Tianjin 300192, China |
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| 张超 |
ZHANG Chao |
天津中医药大学第一附属医院 国家中医针灸临床医学研究中心 国家中医药管理局区域中医骨伤科诊疗中心, 天津 300192 |
The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Regional TCM Orthopedic Treatment Center of State Administration of Traditional Chinese Medicine, Tianjin 300192, China |
|
| 苏瑾 |
SU Jin |
天津中医药大学第一附属医院 国家中医针灸临床医学研究中心 国家中医药管理局区域中医骨伤科诊疗中心, 天津 300192 |
The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Regional TCM Orthopedic Treatment Center of State Administration of Traditional Chinese Medicine, Tianjin 300192, China |
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| 李远栋 |
LI Yuan-dong |
天津中医药大学第一附属医院 国家中医针灸临床医学研究中心 国家中医药管理局区域中医骨伤科诊疗中心, 天津 300192 |
The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Regional TCM Orthopedic Treatment Center of State Administration of Traditional Chinese Medicine, Tianjin 300192, China |
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| 杨光 |
YANG Guang |
天津中医药大学第一附属医院 国家中医针灸临床医学研究中心 国家中医药管理局区域中医骨伤科诊疗中心, 天津 300192 |
The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Regional TCM Orthopedic Treatment Center of State Administration of Traditional Chinese Medicine, Tianjin 300192, China |
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| 王平 |
WANG Ping |
天津中医药大学第一附属医院 国家中医针灸临床医学研究中心 国家中医药管理局区域中医骨伤科诊疗中心, 天津 300192 |
The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Regional TCM Orthopedic Treatment Center of State Administration of Traditional Chinese Medicine, Tianjin 300192, China |
376979975@qq.com |
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| 期刊信息：《中国骨伤》2023年，第36卷，第1期，第17-24页 |
| DOI：10.12200/j.issn.1003-0034.2023.01.004 |
| 基金项目:天津市教委科研计划项目(编号:2019KJ064) |
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中文摘要:
目的:观察不同年龄段经皮椎间孔镜下髓核摘除术(percutaneous endoscopic transforaminal discectomy,PETD)和靶点射频热凝术(coblation nucleoplasty,CN)对包容型腰椎间盘突出症(lumbar disc herniation,LDH)的疗效,为临床制定精准化、个体化的治疗方案提供依据。
方法:对2018年1月至2021年6月采用PETD和CN治疗的腰椎间盘突出症219例患者进行回顾性分析,其中PETD治疗107例,CN治疗112例,依据年龄将两种不同手段治疗的患者分为青年组(≤ 45岁)、中年组(>45岁且<60岁)和老年组(≥ 60岁)。于治疗前,治疗后3 d及1、6个月评价疼痛视觉模拟评分(visual analogue scale,VAS),日本骨科学会(Japanese Orthopaedic Association,JOA) 腰痛评分,红外热成像温差值(△T)及腰椎活动度(range of motion,ROM),比较不同年龄段之间两种治疗手段的疗效差异。
结果:VAS和JOA评分观察:(1)同年龄段组内比较。①同年龄段、同一治疗方法、不同时刻的VAS和JOA评分与治疗前比较差异有统计学意义(P＜0.05),治疗后均有明显改善;②同年龄段、不同治疗方法,老年组PETD治疗后VAS较CN治疗后低、JOA评分较CN后高(P＜0.05),青年组及中年组患者中两种治疗方法之间差异无统计学意义(P＞0.05)。(2)不同年龄段组间比较。①PETD治疗、不同年龄段、同一时刻比较,VAS和JOA评分差异无统计学意义(P＞0.05);②CN治疗、不同年龄段、同一时刻比较,治疗后1、6个月老年组VAS均高于青年组和中年组(P＜0.05),JOA评分均低于青年组和中年组低(P＜0.05)。红外热成像温差和腰椎活动度观察:(1)同年龄段组内比较。①同年龄段、同一治疗方法△T和ROM都较治疗前显著改善(P＜0.05);②同年龄段、不同治疗方法,PETD和CN治疗后△T的差异均无统计学意义(P＞0.05),青年组和中年组ROM的差异无统计学意义(P均>0.05),老年组内PETD治疗后的ROM较CN治疗后高(P＜0.05)。(2)不同年龄段组间比较。①PETD治疗、不同年龄段、同一时刻比较,△T和ROM的差异均无统计学意义(P＞0.05);②CN治疗、不同年龄段、同一时刻比较,治疗后△T差异无统计学意义,但老年组ROM小于青年和中年组(P＜0.05)。
结论:PETD和CN治疗包容型LDH均有较好的疗效,术后6个月内老年患者接受PETD治疗的疗效收益大于CN,CN更适用于青、中年人。 |
| 【关键词】腰椎 椎间盘移位 外科手术,内窥镜 射频消融术 |
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| Comparison of clinical efficacy between percutaneous endoscopic transforaminal discectomy and coblation nucleoplasty in the treatment of inclusive lumbar disc herniation |
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ABSTRACT
Objective To observe clinical efficacy of percutaneous endoscopic transforaminal discectomy (PETD) and target radioffrequency thermal coblation nucleoplasty(CN) on inclusive lumbar disc herniation(LDH) in different age groups,and provide a basis for clinical formulation of precise and individualized treatments.
Methods A retrospective analysis of 219 patients with lumbar disc herniation treated with PETD and CN between January 2018 and June 2021 was performed,in which 107 patients were treated with PETD and 112 with CN. Patients were stratified by age into young group(≤ 45 years old),middle-aged group(>45 years old and <60 years old) and older group(≥ 60 years old). Before treatment,3 days,1 month and 6 months after treatment,visual analogue scale (VAS),Japanese Orthopaedic Association (JOA) score,infrared thermal imaging temperature difference (△T) and lumbar range of motion (ROM) were evaluated and clinical efficacy were compared in the different age groups between two treatment methods.
Results ①VAS and JOA score outcomes,in the same age group and the same treatment method,the VAS and JOA scores at different time points postoperatively were obviously improved (P＜0.05). For the same age group and the different treatment methods,the older group had lower VAS and higher JOA scores after PETD than after CN (P＜0.05),and there was no significant difference between the young group and middle-aged group (P＞0.05). There was no significant difference in VAS and JOA scores at the same time between age groups by PETD treatment (P＞0.05). The VAS was higher and the JOA score was lower in older group than in young group and middle-aged group at 1,6 months after CN treatment(P＜0.05). ②△T and ROM outcomes,in the same age group and same treatment method,postoperative △T and ROM at different time points were obviously improved(P＜0.05). There was no significant difference in △T between two methods of PETD and CN at the same age(P＞0.05),there was no significant difference in ROM between young group and middle-aged group(P＞0.05),ROM was higher after PETD treatment than after CN treatment(P＜0.05). There was no significant difference in △T and ROM at the same time between age groups by PETD treatment(P＞0.05). There was no significant difference in △T between age groups by CN treatment,but the ROM was smaller in older group than in young group and middle-aged group after CN treatment(P＜0.05).
Conclusion Both PETD and CN for inclusive LDH have good efficacy,the curative benefit for older patients receiving PETD within 6 months after surgery more than CN,and CN is more appropriate for young and middle-aged patients. |
| KEY WORDS Lumbar vertebrae Intervertebral disk displacement Surgical procedures,endoscopic Coblation nucleoplasty |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 霍路遥,于大伟,冯天笑,符碧峰,张超,苏瑾,李远栋,杨光,王平.椎间孔镜下髓核摘除术和靶点射频热凝术治疗包容型腰椎间盘突出症的疗效比较[J].中国骨伤,2023,36(1):17~24 |
| 英文格式: | HUO Lu-yao,YU Da-wei,FENG Tian-xiao,FU Bi-feng,ZHANG Chao,SU Jin,LI Yuan-dong,YANG Guang,WANG Ping.Comparison of clinical efficacy between percutaneous endoscopic transforaminal discectomy and coblation nucleoplasty in the treatment of inclusive lumbar disc herniation[J].zhongguo gu shang / China J Orthop Trauma ,2023,36(1):17~24 |
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