经皮椎间孔镜髓核摘除术与传统后路髓核摘除术治疗单节段LDH患者的血清CPK变化及临床疗效分析-东南大学学报医学版

经皮椎间孔镜髓核摘除术与传统后路髓核摘除术治疗单节段LDH患者的血清CPK变化及临床疗效分析

单位：揭阳市人民医院脊柱外科, 广东揭阳 522000

分类号：R681.5

出版年·卷·期（页码）：2019·38·第一期（108-112）

摘要：

目的：观察两种方法经皮椎间孔镜髓核摘除术（PELD）与传统后路髓核摘除术（FD）治疗单节段椎间盘突出症（LDH）的血清肌酸磷酸激酶（CPK）变化及临床疗效。方法：搜集2015年1月至2016年12月揭阳市人民医院骨科行PELD手术65例（PELD组）和传统后路髓核摘除术30例（FD组）的单节段LDH患者临床资料。观察所有患者术前、术后1天、术后3个月、术后6个月及术后1年的日本骨科协会疗效评分（JOA）及视觉模拟评分（VAS），同时采用MacNab疗效标准对其临床疗效进行评估。同时观察术前、术后1 h、术后6 h、术后24 h的血清CPK指标的变化。结果：PELD组的术后1 d、术后3个月的JOA评分高于FD组，差异有统计学意义（P<0.05）；术后6个月与术后1年之间比较差异无统计学意义（P>0.05）。PELD组的VAS评分、ODI%术后1 d、术后3个月较FD组降低，差异有统计学意义，术后6个月与术后1年比较无明显差异。PELD组术后6 h、12 h及24 h的血清CPK指标显著低于FD组。术后随访1年根据改良MacNab标准进行临床疗效评级，两种方式的优良率为89.2%（PELD组）、83.3%（FD组）。结论：PELD治疗腰椎间盘突出症肌肉组织损伤小、临床疗效确切，是一种十分理想的手术方式，值得临床推广。

Objective:To analyze the clinical effect and changes of serum CPK of percutaneous endoscopic lumbar discectomy(PELD) and traditional fenestration discectomy(FD) in the treatment of single segment lumbar disc herniation(LDH). Methods:Sixty-five cases single segment lumbar disc herniation with percutaneous endoscopic lumbar discectomy and 30 cases with traditional fenestration discectomy in the orthopedics department of Jieyang People's hospital from January 2015 to December 2016 were enrolled in the study. All patients were observed before surgery, 1 day after surgery, 3 months after surgery, 6 months after surgery and 1 year after surgery, and their clinical efficacy was evaluated using Japanese Orthopaedic Association Scores(JOA), Visual Analog Scores(VAS) and MacNab therapeutic standard as well as the changes of serum CPK. Results:JOA score 1d postoperatively and 3 months postoperatively in PELD group were higher than FD group, and the difference was statistically significant. And there was no statistically significant difference between 6 months postoperatively and 1 year postoperatively. However, VAS score and ODI% in PELD group significantly decreased 1d postoperatively and 3 months postoperatively compared to FD group. And also, there was no significant difference between 6 months postoperatively and 1 year postoperatively. In addition, the changes of serum CPK at 6 h, 12 h and 24 h after PELD were remarkably reduced than FD. After 1 year of follow-up, clinical efficacy was evaluated with an excellent rate of 89.2%(PELD group) and 83.3%(FD group) according to modified MacNab standard. Conclusion:PELD has definite clinical effect in treating lumbar disc herniation, and is an ideal surgery way.

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