椎间盘镜与椎板开窗髓核摘除术治疗腰椎间盘突出症对疗效、JOA评分及并发症的影响

陈江民 孙超 徐希彦 丁洪艳 秦川

[摘要] 目的 觀察椎间盘镜与椎板开窗髓核摘除术治疗腰椎间盘突出症对疗效、JOA评分及并发症的影响。 方法 随机选择2019年1～12月来我院进行腰椎间盘突出症治疗患者90例，使用随机数字表将患者分为观察组和对照组，各45例。对照组患者给予椎板开窗髓核摘除术。观察组患者给予椎间盘镜行手术治疗。随访6个月，比较两组患者临床疗效、JOA评分及术后并发症发生率。 结果 观察组患者治疗总有效率为93.33%，高于对照组的88.89%，但差异无统计学意义（P>0.05）。治疗后6个月，两组患者JOA评分均有所提升，但观察组评分明显高于对照组，差异有统计学意义（P<0.05）。观察组术后并发症发生率（4.44%）明显低于对照组的17.78%，差异有统计学意义（χ2=4.050，P=0.044）。 结论 两种术式临床疗效相当，但是椎间盘镜术患者术后神经恢复更好，同时术后并发症更低，也更为安全。

[关键词] 椎间盘镜;椎板开窗髓核摘除术;腰间盘突出症;JOA评分

[中图分类号] R687.3          [文献标识码] B          [文章编号] 1673-9701（2020）22-0085-03

Impacts of microendoscopic discectomy and open-window discectomy on the efficacy，JOA score and complications of lumbar disc herniation

CHEN Jiangmin   SUN Chao   XU Xiyan   DING Hongyan   QIN Chuan

Orthopedics Department，Chongqing Renji Hospital Affiliated to University of Chinese Academy of Sciences（the Fifth Peoples Hospital of Chongqing），Chongqing   400062，China

[Abstract] Objective To observe the impacts of microendoscopic discectomy and open-window discectomy on the efficacy，JOA score and complications of lumbar disc herniation. Methods 90 patients with lumbar disc herniation admitted tissue our hospital for treatment from January to December 2019 were randomly selected and divided into the observation group（n=45） and the control group（n=45） by random number table method. Patients in the control group were treated with the open-window discectomy，while patients in the observation group were treated with  microendoscopic discectomy. After 6-month following-up，the clinical efficacy， JOA score and incidence of postoperative complications were compared between the two groups. Results The total efficacy rate of the observation group was 93.33%，higher than 88.89% in the control group. However， there was no statistically significant difference between the two groups （P>0.05）. Six months after treatment， the JOA scores of the two groups both increased， but the scores of the observation group were significantly higher than those of the control group，with statistically significant difference（P<0.05）. The incidence of postoperative complications in the observation group（4.44%） was significantly lower than that in the control group（17.78%）， with statistically significant difference（χ2=4.050， P=0.044）. Conclusion The clinical efficacies of the two operation types are equivalent，but the postoperative neurological recovery of patients undergoing microendoscopic discectomy is better，and the incidence of postoperative complications are lower，which is safer.

[Key words] Intervertebral disc endoscope; Open-window discectomy; Lumbar disc herniation; JOA score

腰椎间盘突出症是临床常见的骨科疾病，患者以不同程度的腰腿疼痛为主要临床症状[1]。有数据显示我国60岁以上的人口中46.8%患有不同程度的腰椎间盘突出症。近年来该疾病患病人群呈现年轻化的特点，因此对腰椎间盘突出症的治疗成为临床研究的课题。虽然保守治疗是首选治疗方案，但是对于部分严重患者必须要进行手术治疗。椎板开窗髓核摘除术是传统的手术方案，对患者损伤较大、并发症较多[2]。近年来椎间盘镜的应用为腰椎间盘突出症的手术治疗提供了新的途径[3]。本研究旨在观察两种术式对患者预后的影响，现报道如下。

1 资料与方法

1.1 一般资料

选择2019年1～12月来我院治疗腰椎间盘突出症患者90例进行临床研究。采用……