目的 探讨腰椎经皮内镜手术(PELD)中腰痛与切除钙化型腰椎间盘的关系。方法 选择解放军总医院骨科2019-01至2021-12局麻下采取PELD治疗腰椎间盘突出症患者81例,以术前CT影像资料中突出间盘钙化与否分为钙化组和非钙化组,当术中钳夹或电凝处理突出的退变间盘时,记录两组患者术中腰痛的平均视觉模拟评分(VAS),比较两组术中腰痛VAS,并用改良Macnab评定优良率来比较术中满意度。结果 钙化组钳夹VAS为(4.86±1.29)分,非钙化组钳夹VAS为(1.13±0.72)分;钙化组电凝VAS为(5.43±1.74)分,非钙化组电凝VAS为(2.07±1.91)分,两组比较差异均有统计学意义(P＜0.05);术中满意度Macnab评级优良率,非钙化组高于钙化组(86.67% vs. 66.66%),两组比较差异有统计学意义(P＜0.05)。结论 PELD术中处理钙化间盘可能诱发患者剧烈腰痛无法耐受手术,间盘的钙化变性可能是下腰痛的诱发因素。
Abstract
Objective To investigate the relationship between low back pain in percutaneous endoscopic lumbar discectomy (PELD) and resection of calcified lumbar disc herniation. Methods A total of 81 patients with lumbar disc herniation were selected from the Department of Orthopedics of PLA General Hospital from January 2019 to December 2021 who were treated with PELD under local anesthesia. According to the preoperative CT image data, the patients were divided into the calcified group and the non-calcified group. The average visual analog score (VAS) of intraoperative low back pain between the two groups was recorded, the intraoperative low back pain VAS between the two groups was compared, and the excellent and good rate of modified Macnab was used to compare the intraoperative satisfaction. Results There was no demographic significance in two groups. VAS of intraoperative low back pain between two groups, were significantly different (VAS of calcified group by endoscopic clamp was 4.86±1.29 vs non-calcified group was 1.13±0.72, VAS of calcified group by electrocoagulation was 5.43±1.74 vs non-calcified group was 2.07±1.91). Besides, modified MacNab criteria between the two groups were also significantly different (66.66% vs 86.67%; P<0.05). Conclusions The treatment of calcified lumbar intervertebral disc herniation in PELD may lead to severe low back pain in patients who cannot tolerate surgery, and the calcification of intervertebral discs may be a predisposition factor for low back pain.
关键词
腰椎间盘突出 /
钙化 /
腰椎经皮内镜髓核切除术 /
腰痛 /
术中
Key words
lumbar intervertebral disc herniation /
calcification /
percutaneous endoscopic lumbar discectomy (PELD) /
low back pain /
intraoperative period
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