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中华腔镜外科杂志(电子版)

中华腔镜外科杂志(电子版) ›› 2016, Vol. 09 ›› Issue (05): 257 -261. doi: 10.3877/cma.j.issn.1674-6899.2016.05.001

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经皮内镜腰神经根减压术后疼痛症状改善进展的研究
黄良诚 1, 郭燕梅 2, 李宁 1, 陈锦旭 1, 曾祥超 1, 车路阳 1, 郭清华 1, 薛大鹏 1, 张西峰 1, 黄鹏 1 , †( )   
  1. 1. 100853 北京，解放军总医院骨科
    2. 100853 北京，解放军总医院南楼康复科
  • 收稿日期:2016-07-25 出版日期:2016-10-30
  • 通信作者: 黄鹏

The study of the early recovery in low back pain and leg pain after the percutaneous endoscopicsurgery

Liangcheng Huang 1, Yanmei Guo 2, Ning Li 1, Jinxu Chen 1, Xiangchao Zeng 1, Luyang Che 1, Qinghua Guo 1, Dapeng Xue 1, Xifeng Zhang 1, Peng Huang 1 , †( )   

  1. 1. Department of Orthopedics, General Hospital of PLA, Beijing 100853, China
    2. Department of Rehabilitation, Nanlou of Chinese PLA General Hospital, Beijing 100853, China
  • Received:2016-07-25 Published:2016-10-30
  • Corresponding author: Peng Huang
  • About author:
    Corresponding author: Huang Peng, Email:
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目的

观察评估经皮脊柱内镜腰神经根减压术(PELD)术后腰腿疼痛症状的早期改善进展。

方法

对解放军总医院2015年1月至2016年1月连续93例中84例PELD治疗腰背痛及神经根性疼痛症状的患者，前瞻性记录术后12周(各1周1次)的腰背痛视觉模拟评分(VAS)和下肢痛VAS，观察评估两种疼痛症状的改善进展并比较两者的改善度，用术后12周时腰背痛及下肢痛VAS、功能障碍指数评分(ODI)和改良MacNab疗效评定标准评价手术疗效。

结果

腰背痛症状术后VAS评分相邻两周间比较，差异无统计学意义(P> 0.05)；下肢痛症状术后VAS评分的术后2周与术后1周比较[(2.96 ± 1.97)分 vs (2.10 ± 1.29)分]、术后4周与术后3周比较[(2.04 ± 1.62)分 vs (2.46 ± 1.97)分]，差异有统计学意义(P<0.05)；余下相邻两周间比较，差异无统计学意义(P > 0.05)；下肢痛术后12周VAS改善度与腰背痛VAS改善度比较[(6.64 ± 1.47)分 vs (3.36 ± 1.38)分]，差异有统计学意义(P < 0.05)；术后12周时ODI、腰背痛VAS、下肢痛VAS均较术前显著降低[(12.82 ± 6.39)分 vs (53.64 ± 11.73)分、(1.16 ± 1.06)分 vs (4.52 ± 0.65)分、(1.29 ± 1.30)分 vs (7.93 ± 0.81)分]，改良MacNab疗效评定标准评价优良率为86%。

结论

PELD术后早期12周，腰背痛的症状改善平稳，下肢痛的症状改善在术后2周、术后3周出现波动，下肢痛症状比腰背痛症状改善更快，手术疗效显著。

关键词: 下腰痛, 神经根性病变, 改善进展, 经皮脊柱内镜, 减压术
Objectives

To observe and assess the early recovery in low back pain and leg pain after the decompression of lumbar nerve root using percutaneous endoscopic lumbar discectomy (PELD).

Methods

From Jan. 2015 to Jan. 2016, in 93 consecutive patients, 84 consecutive patients with low back pain and radicular pain were treated by using PELD. Visual analog score (VAS) of low back pain and leg pain were collected once a week, at consecutively postoperative 12 weeks , then compared the scores between adjacent two weeks separately. Outcome measures consisted of Oswestry Disability Index score (ODI) and VAS score of low back pain and leg pain between preoperative and postoperative, and modified MacNab criteria were compared.

Results

There was no difference between the adjacent two weeks in postoperative low back pain VAS score (P> 0.05). The difference of postoperative leg pain VAS score between 2 weeks and 1 week [(2.96 ± 1.97) vs (2.10 ± 1.29)], 4 weeks and 3 weeks [(2.04 ± 1.62) vs (2.46 ± 1.97)], were significant (P< 0.05). There was no difference of postoperative leg pain VAS score between other adjacent 2 weeks (P> 0.05). The ODI score and VAS score of low back pain and leg pain at 12 weeks postoperative were lower significantly than at preoperative [(12.82 ± 6.39) vs (53.64 ± 11.73), (1.16 ± 1.06) vs (4.52 ± 0.65), (1.29 ± 1.30) vs (7.93 ± 0.81)]. Based on the evaluation of the modified MacNab, excellent and good rate was 86%.

Conclusions

There was no obvious fluctuation in postoperative low back pain, and there were obvious fluctuations in postoperative leg pain at 2 weeks and 3 weeks. With 12 weeks follow-up, PELD had a better result in low back pain, leg pain and state of life.

Key words: Low back pain, Radicular neuropathy, Recovery, Percutaneous endoscopic lumbar discectomy (PELD), Surgical decompression
图1 神经根性腰腿疼痛患者的术前影像资料
图2 神经根性腰腿疼痛患者的术中穿刺、置管的C臂机透视
图3 神经根性腰腿疼痛患者的术中镜下
表1 神经根性腰腿疼痛患者的术前、术后12周的ODI、腰背痛VAS、腿痛VAS评分比较(分， ± s)
项目 ODI 腰背痛VAS 下肢痛VAS
术前 53.64 ± 11.73 4.52 ± 0.65 7.93 ± 0.81
术后12周 12.82 ± 6.39 1.16 ± 1.06 1.29 ± 1.30
表2 神经根性腰腿疼痛患者的术后1～12周腰背痛、下肢痛VAS评分(分， ±s)
术后 腰背痛VAS 下肢痛VAS
1周 1.80 ± 0.87 2.10 ± 1.29
2周 1.88 ± 0.88 2.96 ± 1.97
3周 2.12 ± 1.24 2.46 ± 1.97
4周 1.88 ± 1.30 2.04 ± 1.62
5周 1.80 ± 1.69 1.79 ± 1.70
6周 1.56 ± 1.42 1.82 ± 1.59
7周 1.60 ± 1.22 1.64 ± 1.64
8周 1.52 ± 1.26 1.75 ± 1.51
9周 1.56 ± 1.36 1.68 ± 1.56
10周 1.32 ± 0.99 1.50 ± 1.35
11周 1.40 ± 1.22 1.46 ± 1.29
12周 1.16 ± 1.07 1.29 ± 1.30
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