经皮内窥镜下椎间盘摘除联合富血小板血浆凝胶微球置入治疗腰椎间盘突出症的疗效观察

Clinical observation of percutaneous endoscopic lumbar discectomy combined with platelet-rich plasma gel microspheres implantation for the treatment of lumbar disc herniation

中文关键词:  腰椎间盘突出症  内窥镜下椎间盘切除术  富血小板血浆微球  微创手术

英文关键词:Lumbar disc herniation  Percutaneous endoscopic lumbar discectomy  Platelet-rich plasma  Minimally invasive surgery

中文摘要:

  【摘要】 目的：分析经皮内窥镜下椎间盘摘除（percutaneous endoscopic lumbar discectomy，PELD）联合富血小板血浆（platelet-rich plasma，PRP）凝胶微球置入治疗腰椎间盘突出症的安全性及有效性。方法：2017年2月～2018年2月选取腰椎间盘突出症患者40例，随机分为观察组与对照组，每组20例，观察组男11例，女9例，年龄19～68岁（47.8±13.5岁），病程3～48个月（18.4±12.5个月）；病变节段：L3/4 4例，L4/5 9例，L5/S1 7例；行PELD、PRP凝胶微球置入；对照组男10例，女10例，年龄27～62岁（45.9±10.5岁），病程5～54个月（21.9±13.4个月）；病变节段：L3/4 3例，L4/5 11例，L5/S1 6例；行PELD。记录并比较两组患者治疗前、治疗后12个月及末次随访时的VAS评分、腰椎JOA评分及Oswestry功能障碍指数（ODI），在术前和末次随访时的腰椎X线片上测量手术椎间隙高度，MRI上评估手术椎间盘Pfirrmann分级情况。结果：两组患者术前一般资料比较差异无统计学意义（P>0.05）。两组患者均获随访，随访时间22～27个月（24.2±1.9个月），随访期间均未出现严重不良反应及并发症。两组患者治疗前的VAS评分、JOA评分、ODI和椎间盘Pfirrmann分级均无显著性差异（P>0.05）。治疗后12个月和末次随访时与同组治疗前比较明显改善（P<0.05）；治疗后12个月及末次随访时两组间比较差异无统计学意义（P>0.05）。末次随访时对照组椎间隙高度降低大于观察组，且差异有统计学意义（P=0.005）；观察组椎间盘退变Pfirrmann分级与对照组比较差异有统计学意义（P=0.031）。结论：PELD联合PRP凝胶微球置入治疗腰椎间盘突出症安全有效，且可在一定程度上延缓椎间盘退变，促进椎间盘修复。

英文摘要:

  【Abstract】 Objectives: To analysis the safety and efficacy of percutaneous endoscopic lumbar discectomy(PELD) combined with platelet-rich plasma(PRP) gel microspheres implantation in patients with lumbar disc herniation(LDH). Methods: From February 2017 to February 2018, 40 patients with LDH treated in our department were randomly divided into observation group and control group, with 20 cases in each group. The observation group was treated with PELD combined with PRP gel microspheres implantation. The patients in observation group included 11 males and 9 females, with an average of 47.8±13.5 years old ranging from 19 to 68 years. The average course of disease was 18.4±12.5 months ranging from 3 to 48 months, with L3/4 4 cases, L4/5 9 cases, and L5/S1 7 cases. The patients in the control group were treated with PELD, including 10 males and 10 females with an average age of 45.9±10.5 years ranging from 27 to 62 years. The average course of disease was 21.9±13.4 months ranging from 5 to 54 months, with L3/4 3 cases, L4/5 11 cases, and L5/S1 6 cases. All the patients were evaluated before the treatment, at the 12th month and final follow-up after the treatment by VAS score, JOA score and Oswestry defunction index(ODI). The intervertebral space height was measured on lumbar X-ray, and Pfirrmann classification on MRI was evaluated before treatment and at final follow-up. Results: There was no significant difference in general data between the two groups(P>0.05). All 40 patients were followed up for 22 to 27 months(averaged 24.2±1.9 months), with no serious adverse reaction or complication. For VAS, JOA, ODI scores and Pfirrmann classification, there was no significant difference between the two groups before the treatment(P>0.05). In each group they were significantly improved at the 12th month postoperatively and the final follow-up comparing with that before operation(P<0.05). There was no significant difference between the two groups at the 12th month and the final follow-up(P>0.05). However, the changes of intervertebral space height and Pfirrmann classification of observation group were significantly better than that in control group at final follow-up(P=0.005, P=0.031). Conclusions: PELD combined with PRP is safe and effective in the treatment of LDH. To some extent, it can slow down disc degeneration and promote disc repair.