内镜与开放减压融合手术治疗年轻肥胖腰椎间盘突出症病人临床疗效对照研究

Comparative study of the clinical effect between full-endoscopic operation and open decompression fusion in the treatment of young obese patients with lumbar disc herniation

摘要:

目的：评估内镜下减压手术与开放减压固定融合手术治疗年轻肥胖腰椎间盘突出症的中期临床疗效。方法：回顾分析2015年1月到2017年6月期间在我院疼痛医学中心及骨科脊柱组确诊为腰椎间盘突出症并接受手术治疗的病人。以年龄18~45岁，BMI ≥ 28 kg/ m2 ，因腰椎间盘突出症而接受手术治疗为入组标准。根据病人接受术式不同分为内镜组（62例）及开放组（25例）。以术前及术后视觉模拟评分（visual analogue scale, VAS）、重返工作时间、MacNab评分、术后再手术率作为评价指标，分析两组差异，比较两术式的临床疗效。结果：内镜组重返工作时间平均3.21±6.25月。MacNab评分结果：（50优、5良、1可、6差），优秀率：80.65%。10人术后症状复发再次接受手术(再手术率16.13%）；开放组重返工作时间平均5.73±4.22月。MacNab评分结果：（20优、4良、0可、1差），优秀率：80.00%。1人因症状复发接受手术(再手术率4%）。两组病人MacNab评分无统计学差异(P>0.05)，重返工作时间有统计学差异 (P < 0.05)，术后复发时间有统计学差异(P<0.05)。两组术后VAS评分均较术前明显下降。结论：年轻肥胖腰椎间盘突出症病人接受脊椎内镜术后再手术率较开放减压固定融合术高，两者疗效相当，脊椎内镜术后恢复时间更短，病人能更快地重回工作，恢复其社会角色。

Abstract:

Objective: To evaluate the mid-term clinical effect of endoscopic decompression and open decompression and fixation fusion in the treatment of young obese lumbar disc herniation. Methods: From January 2015 to June 2017, the patients who were diagnosed as lumbar disc herniation in pain medical center and spine group of orthopedics department of our hospital were analyzed retrospectively. The age of 18-45 years old, BMI ≥ 28 kg / m2, and surgical treatment for lumbar disc herniation were included as the criteria. The patients were divided into endoscopic group (62 cases) and open group (25 cases). The visual analog scale (VAS), the time to return to work, the MacNab score and the rate of reoperation were used as the evaluation indexes. The differences between the two groups were analyzed and the clinical effects were compared. Results: The average back to work time of Endoscopy Group was 3.21 ± 6.25 months. The results of MacNab : (50 excellent, 5 good, 1 fair, 6 poor), the excellent rate was 80.65%. In the open group, the mean time of back to work time was 5.73 ± 4.22 months. The results of MacNab : (20 excellent, 4 good, 0 fair, 1 poor), the excellent rate was 80.00%. One patient received open surgery (reoperation rate 4%) because of symptom recurrence. There was no significant difference in the MacNab score between the two groups (P > 0.05). There was a significant difference in the time of returning to work (P < 0.05). There was a significant difference in the time of recurrence (P < 0.05). The VAS score of the two groups was significantly lower than that before operation. Conclusion: The recurrence rate of young obese patients with lumbar disc herniation who accept endoscopic operation is higher than who accept open decompression fixation and fusion surgery, The clinical effect of those two operations are equivalent. The recovery time of patients after the endoscopic operation is shorter, and the patients can return to work and restore their social roles faster.