| 王居勇 王居强 王华 王宝宝 刘征宇 彭建光 张庆明 鲁世保.腰椎间盘突出症阶梯式手术治疗方案的临床疗效和患者心理状况调查[J].,2016,16(28):5444-5447 |
| 腰椎间盘突出症阶梯式手术治疗方案的临床疗效和患者心理状况调查 |
| Investigation on Clinical Efficacy and Patient Satisfaction of Step OperationTreatment for Lumbar Disc Herniation |
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| DOI： |
| 中文关键词: 腰椎间盘突出 内窥镜技术 最小侵入性 开窗髓核摘除术 心理调查 |
| 英文关键词: Lumbar disc herniation Endoscopy Minimally invasive surgery Fenestration Discectomy Psychological investigation |
| 基金项目:北京自然科学基金项目（3112012） |
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| 中文摘要: |
| 目的：探讨阶梯式手术治疗方案对腰椎间盘突出的临床疗效和患者对临床疗效的心理接受情况。方法：回顾性分析2014 年
至2016 年本院骨科确诊为腰椎间盘突出症的50 例患者，经椎间孔镜下行髓核摘除微创手术(Percutaneous transforaminal
endoscopic discectomy, PTED)，术后1 天和3 个月采用视觉疼痛模拟评分(VAS) 和改良MacNab 疗效评定、术后3 个月采用
Oswestry功能障碍指数(ODI)评价手术效果，以及相应调查时间点患者对手术效果心理接受程度调查；对于7 例微创手术疗效不
佳患者进一步采用传统的开窗髓核摘除术(Fenestration discectomy, FD)，采用同样方法评价手术效果和调查患者心理接受情况。
结果：50 例微创术后1 天及术后3 个月的VAS 评分和ODI 指数均显著低于术前,差异具有显著性(P 均<0.05)；改良MacNab 疗
效评定：术后1 天优良率为84 %，术后3个月为86 %；患者对术后疗效心理满意度调查：术后1 天，满意并接受为84 %，不满意但
接受为16 %，不满意难接受为0；术后3个月，满意并接受为86 %，不满意但接受为14 %，不满意难接受为0。对于微创术后效果
欠佳7 例患者行FD 手术，术后1 天及3 个月的VAS 评分和ODI 指数均显著低于术前, 差异具有显著性(P 均<0.05)；改良
MacNab 疗效评定：术后1 天优良率为71%，术后3 个月为100 %；患者对开窗术后疗效心理满意度调查：术后1 天，满意并接受
为71%，不满意但接受为0，不满意难接受为29 %；术后3个月，满意并接受为100 %，不满意但接受为0，不满意难接受为0。结
论：腰椎间盘突出症阶梯式手术治疗方案临床效果和患者心理接受情况均值得临床推荐。 |
| 英文摘要: |
| Objective:To study the clinical efficacy and psychological acceptance of patients with lumbar disc herniation by step
operation treatment.Methods:50 patients with lumbar disc herniation were treated with percutaneous transforaminal endoscopic
discectomy (PTED) from 2014 to 2016 in our hospital, The visual analogue scale (VAS), Oswestry Disability Index (ODI) and the
modified MacNab criteria were used to measure the clinical outcomes at 1 day and 3 months after surgery, the psychological acceptance
of the patients with the corresponding survey time point was Investigated. The 7 patients of poor clinical efficacy after minimally invasive
surgery were to further treated with fenestration discectomy (FD), the clinical outcomes and the psychological acceptance of the patients
were performed with the same ways.Results:At 1 day and 3 months after minimally invasive surgery, The postoperative VAS scores,
ODI were significantly improved when compared with the preoperative ones (P<0.05). The excellent and good rate was 84%and 86%at
postoperative 1 day and 3 months time point according to the modified MacNab criteria. The psychological acceptance of the patients
with the corresponding survey time point: 1 day after surgery, satisfaction and accept is 84 %, dissatisfied but accept is 16 %, dissatisfied
with difficult to accept is 0; 3 months after surgery, satisfaction and accept is 86 %, dissatisfied but accept is 14 %, dissatisfied with
difficult to accept is 0. The 7 patients further treated with fenestration discectomy (FD). The postoperative VAS scores, ODI at 1 day and
3 months after surgery were also significantly improved (P<0.05). The excellent and good rate was 71 % and 100 % at postoperative 1
day and 3 months time point according to the modified MacNab criteria. The psychological acceptance of the patients with the
corresponding survey time point: 1 day after surgery, satisfaction and accept is 71 %, dissatisfied but accept is 0, dissatisfied with difficult to accept is 29 %; 3 months after surgery, satisfaction and accept is 100 %, dissatisfied but accept is 0, dissatisfied with difficult to accept
is 0.Conclusion:No matter clinical efficacy or psychological acceptance of the patients, the stepwise treatments from the PTED to the
FD are worth recommending. |
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