[1]孙德舜,宋义博,李庆斌,等.超声骨刀在椎间孔镜下髓核摘除术中的应用[J].中医正骨,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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超声骨刀在椎间孔镜下髓核摘除术中的应用()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第26卷
期数:
2014年11期
页码:
9-11
栏目:
临床研究
出版日期:
2014-11-30

文章信息/Info

Title:
Application of piezosurgery in transforaminal percutaneous endoscopic discectomy
作者:
孙德舜; 宋义博; 李庆斌; 张建新
山东省章丘市中医医院,山东 章丘 250200
Author(s):
Sun Deshu*; Song Yibo; Li Qingbin; Zhang Jianxin.*
Zhangqiu Hospital of Traditional Chinese Medicine,Zhangqiu 250200,Shandong,China
关键词:
超声骨刀 椎间盘移位 腰椎 椎间盘切除术; 经皮
Keywords:
Piezosurgery;  Intervertebral disc displacement;  Lumbar vertebrae;  Surgical procedures; minimally invasive;  Diskectomy; percutaneous
摘要:
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。
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