PELD手术治疗腰椎间盘突出症临床疗效及对患者骨密度 骨代谢指标的影响

摘要

Objective To investigate the clinical effect of PELD surgery on lumbar disc herniation and its influence on bone mineral density and bone metabolism indexes .Methods According to the surgical meth‐od ,97 patients w ith lum bar disc herniation w ere divided into minimally invasive group (PELD surgery ,48 cases) and open group (traditional open surgery ,49 cases).Co mpare the surgical related indicators ,ODI scores before and 3 months af ter surgery of the tw o groups .T he postoperative surgical outco me w as evalu‐ated by modified M acnab efficacy criteria .BM D ,β‐CT x ,osteocalcin and calcitonin levels w ere compared betw een the tw o g roups before and 3 months af ter surgery .Results T he operation time of the minimally invasive group w as significantly longer than that of the open group ( P＜0 .01 ).T he amount of surgical bleeding w as significantly less than that of the open group ( P＜0 .01).T he leng th of the incision w as sig‐nificantly shorter than that of the open group ( P＜0 .01).T he bed time and hospital stay w ere significant‐ly shorter than those of the open group ( P＜0 .01).T he scores of ODI in the tw o groups at 3 months after surgery w ere significantly low er than those before operation ( P＜0 .01).T here w as no significant differ‐ence betw een the tw o g roups ( P＞0 .05).There was no significant difference in the efficacy of Macnab between the tw o groups ( P＞0 .05).T he levels of BM D in the tw o groups at 3 months after surgery w ere sig‐nificantly higher than those before surgery ( P＜0 .01).T here w as no significant difference in the levels of BM D ,β‐CT x ,osteocalcin and calcitonin between the two groups ( P＞0 .05).Conclusion PELD treatment of lumbar disc herniation is equivalent to traditional open surgery .PELD has a short operation time ,less bleeding volume ,small surgical incision and short recovery time ,w hich can significantly im‐prove bone mineral density ,but has little effect on bone metabolism indexes .%目的 探讨经皮全脊柱内镜手术治疗腰椎间盘突出症的临床疗效及对患者骨密度、骨代谢指标的影响.方法 将97例腰椎间盘突出症患者根据手术方法分为微创组48例(经皮全脊柱内镜手术治疗)与开放组49例(传统开放手术治疗) .比较两组患者的手术相关指标,术前及术后3个月Oswestry功能障碍指数问卷表评分,采用改良M acnab疗效评定标准对患者的手术效果进行评价.比较术前及术后3个月两组骨密度、血清胶原分解片段、骨钙素、降钙素水平.结果 微创组手术时间显著长于开放组(P＜0 .01) ,手术出血量显著少于开放组(P＜0 .01) ,切口长度、卧床时间及住院时间均显著短于开放组(P＜0 .01) .术后3个月两组Oswestry功能障碍指数问卷表各项评分均显著低于术前(P＜0 .01) ,两组间评分比较差异无统计学意义(P＞0 .05) .两组患者M acnab疗效比较差异无统计学意义(P＞0 .05) .术后3个月两组骨密度水平显著高于术前(P＜0 .01) ,两组间骨密度、血清胶原分解片段、骨钙素、降钙素水平比较差异无统计学意义(P＞0 .05) .结论 经皮全脊柱内镜手术治疗腰椎间盘突出症与传统开放手术效果相当,经皮全脊柱内镜手术手术时间短,出血量少,手术切口小,恢复时间短,可以显著提高患者骨密度,但对骨代谢指标影响不大.