Effect of transforaminal endoscopic surgery and traditional fenestration operation in the treatment of lumbar disc herniation and their perioperative nursing
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摘要:目的 比较经皮椎间孔镜手术及传统开窗手术治疗腰椎间盘突出症的临床疗效并分析其围术期护理策略。方法 选取60例腰椎间盘突出症患者，按照数字随机法分为研究组和对照组，各30例，研究组采用椎间孔镜手术方式，对照组采用传统开窗手术方式。观察2组患者术中、术后3个月Oswestry功能指数(ODI)评分、疼痛视觉模拟评分法(VAS)评分，并分析护理效果。结果 经及时有效的术前、术后护理干预，60例患者积极配合治疗，均取得了良好的临床效果; 2组患者术后均未发生脑脊液漏、神经根损伤、压疮及下肢静脉血栓等并发症; 研究组切口长度显著短于对照组，术后下地活动时间显著早于对照组(P < 0.05); 术后3个月，2组ODI评分及VAS评分较术前显著改善(P < 0.05); 术前、术后3个月, 2组间ODI评分、VAS评分差异无统计学意义(P>0.05)。结论 与传统开窗手术方式相比，椎间孔镜治疗腰椎间盘突出症患者手术创伤小，术后下地活动时间及恢复工作更早。Abstract:Objective To compare the clinical efficacy of percutaneous transforaminal endoscopic surgery and traditional fenestration surgery in the treatment of lumbar disc herniation, and to analyze the perioperative nursing strategy.Methods A total of 60 lumbar disc herniation patients were randomly divided into study group and control group, with 30 cases in each group, the study group received transforaminal endoscopic surgery, while the control group used the traditional fenestration operation. The changes of Oswestry function index (ODI) and Visual Analogue Scale (VAS) score in the two groups during operation and at 3 months after operation were observed, and nursing effect was analyzed.Results All the 60 patients had better curative efficacy through timely, effective preoperative and postoperative nursing intervention and their actively cooperation. There were no postoperative complications observed such as cerebrospinal fluid leakage, nerve root injury, pressure ulcer and venous thrombosis of lower extremity; the study group had significantly shorter incision length, and earlier ambulance time than the control group (P < 0.05); ODI score and VAS score at 3 months after surgery in two groups were significantly improved (P < 0.05), but had no significance difference before surgery and at 3 months after surgery (P>0.05).Conclusion Compared with traditional fenestration surgery, transforaminal endoscopic discectomy for lumbar disc herniation has less trauma, earlier postoperative activity time and better recovery.
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表 1 2组患者术中、术后相关指标比较(x±s)
组别 n 手术时间/min 切口长度/cm 下地活动时间/d 住院时间/d 对照组 30 74.25±25.68 3.28±0.31 8.56±2.02 10.22±3.15 研究组 30 85.25±28.32* 0.72±0.18* 1.00±1.22* 3.00±0.17* 与对照组比较, *P < 0.05。 
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表 2 2组患者ODI评分、VAS评分比较(x±s)
分 组别 n ODI评分 VAS评分 术前 术后3个月 术前 术后3个月 对照组 30 45.17±7.88 8.88±2.81* 8.12±0.72 0.92±0.33* 研究组 30 44.72±8.78 7.54±2.72* 8.28±0.85 0.88±0.28* 与术前比较, *P < 0.05。
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