1.Haikou Third People'2.'3.s Hospital
摘要 目的 回顾性分析富血小板血浆联合椎间孔镜对腰椎间盘突出患者临床疗效的影响。方法 选择我院自2019年1月至2019年12采用椎间孔镜下腰椎间盘突出症患者73例，其中包括男41例，女32例；年平均48.52±10.36岁；病变节段L3-4 14例、L4-5 37例、L 5-S1 22例。病程平均10.26±4.05个月。突出类型：突出型51例，游离型22例。依据手术方案分为观察组36例（富血小板血浆联合椎间孔镜），对照组37例（单纯椎间孔镜）。观察围术期并发症、疼痛视觉模拟评分、Oswestry 功能碍指数、椎间盘高度指数和Pfirrmann分级。结果①所有患者手术均顺利完成，围手术期无感染病例。硬膜撕裂：观察组2例，其中1例出现脑脊液漏；对照组3例。神经根挫伤：观察组3例，对照组2例，经神经营养、针灸等治疗，2个月随访均恢复。切口血肿：对照组1例，经局部引流。②两组患者获12-18个月随访，平均15.37±1.92个月。随访期间无复发或再次手术病例。术后1个月观察组VAS 显著优于对照组，差异有统计学意义（P<0.05）。末次随访时，观察组的ODI 评分优于对照组，差异有统计学意义（P<0.001）。③两组术前各节段的椎间隙高度比较，差异无统计学意义（P>0.05）。末次随访，观察组的椎间隙高度与术前比较，差异无统计学意义（P>0.05）；观察组中L4-5和L5-S1椎间隙高度显著大于对照组，差异有统计学意义（P<0.05）。④末次随访，椎间盘Pfirrmann分级观察组中Ⅰ-Ⅱ级信号的比例为75.00%（27/36）优于对照组的51.35%（19/37），两组比较差异有统计学意义（X2=4.378，P=0.036）。结论 富血小板血浆联合椎间孔镜治疗腰椎间盘突出症，能够减轻术后炎性反应，改善椎间盘微环境，有利于纤维环的修复和椎间隙稳定。
Abstract Objective To retrospectively analyze the clinical effect of platelet rich plasma(PRP) combined with percutaneous endoscopic lumbar discectomy (PELD).Methods From January 2019 to December 2019, 73 patients with lumbar disc herniation(LDH) were selected, including 41 males and 32 females; the average annual age was 48.52 ± 10.36 years; there were 14 cases of L3-4, 37 cases of L4-5 and 22 cases of L5-S1; the average course of disease was 10.26 ± 4.05 months; protrusion type: 51 cases of protrusion type and 22 cases of free type. According to the operation plan, 36 cases were divided into the observation group (PRP+PELD) and 37 cases were divided into the control group (PELD). Perioperative complications, pain visual analogue score(VAS), Oswestry functional impairment index(ODI), intervertebral height index (IHI) and Pfirrmann grade were observed.Results ① All the operations were completed successfully, and there were no cases of infection during the perioperative period. Dural tear: there were 2 cases in the observation group, of which 1 case had cerebrospinal fluid leakage; There were 3 cases in the control group. Nerve root contusion: 3 cases in the observation group and 2 cases in the control group were treated with neuronutrition and acupuncture, recovered after 2 months of follow-up. Incision hematoma: 1 case in the control group, through local drainage. ②The two groups were followed up for 12-18 months, with an average of 15.37 ± 1.92 months. There was no recurrence or reoperation during follow-up. One month after operation, VAS in the observation group was significantly better than that in the control group (P < 0.05). At the last follow-up, the ODI score of the observation group was better than that of the control group (P < 0.001). ③ At the last follow-up, there was no significant difference in IHI between the observation group and that before operation (P > 0.05); The IHI of L4-5 and L5-S1 in the observation group was significantly higher than that in the control group (P < 0.05). ④ At the last follow-up, the proportion of Pfirrmann grade I-II signals in the observation group was 75.00% (27 / 36), which was better than the control group 51.35% (19 / 37). There was significant difference between the two groups (x2 = 4.378, P = 0.036).Conclusion PRP combined with PELD in the treatment of LDH could reduce postoperative inflammatory reaction, improve the microenvironment of intervertebral disc, and is conducive to the repair of fibrous ring and the stability of the stability of vertebral body.