加速康复外科(ERAS)理念在经皮脊柱内镜下 治疗腰椎间盘突出症的临床应用研究

Clinical Application Research of Enhanced Recovery After Surgery (ERAS) Concept in the Treatment of Lumbar Disc Herniation by Percutaneous Spinal Endoscopy

摘要: 目的：探讨加速康复外科(ERAS)理念在经皮脊柱内镜(PELD)治疗腰椎间盘突出症(LDH)中的临床应用价值。方法：选取2024年7月至2025年10月收治的50例LDH患者，按随机数字表法分为对照组(25例)与实验组(25例)。对照组采用常规围手术期管理，实验组采用ERAS方案。比较两组手术相关指标、疼痛视觉模拟评分(VAS)、腰椎ODI指数及并发症发生率。结果：实验组术后下床活动时间(14.2 ± 3.5) h、住院时长(3.1 ± 0.8) d均短于对照组(28.6 ± 5.2) h、(5.7 ± 1.2) d (t = 9.824, 7.931, P < 0.001)；术后3 d实验组VAS评分(2.1 ± 0.6)分低于对照组(4.3 ± 0.9)分(t = 8.562, P < 0.001)；腰椎ODI指数对比，实验组术后3 d (18.3 ± 3.2)分低于对照组(29.5 ± 4.1)分(t = 9.215, P < 0.001)；实验组并发症发生率6.67%低于对照组33.33% (χ² = 3.927, P = 0.048)；术后1月两组VAS评分(实验组1.2 ± 0.3分vs对照组1.3 ± 0.4分，t = 0.987，P = 0.329)、腰椎ODI指数(实验组10.2 ± 2.1分vs对照组10.5 ± 2.3分，t = 0.452，P = 0.653)对比差异无统计学意义(P > 0.05)。结论：ERAS理念应用于PELD治疗LDH方面可加速患者康复进程，减轻术后早期疼痛，加速床位周转，降低并发症风险，临床效果显著。

Abstract: Objective: To explore the clinical application value of the enhanced recovery after surgery (ERAS) concept in percutaneous endoscopic lumbar discectomy (PELD) for the treatment of lumbar disc herniation (LDH). Methods: Fifty patients with LDH admitted from July 2024 to October 2025 were randomly divided into a control group (25 cases) and an experimental group (25 cases) using a random number table. The control group received conventional perioperative management, while the experimental group was managed with the ERAS protocol. Surgical-related indicators, visual analogue scale (VAS) for pain, Oswestry Disability Index (ODI) for the lumbar spine, and the incidence of complications were compared between the two groups. Results: The postoperative time to ambulation (14.2 ± 3.5 h) and hospital stay (3.1 ± 0.8 d) in the experimental group were shorter than those in the control group (28.6 ± 5.2 h and 5.7 ± 1.2 d, respectively; t = 9.824, 7.931, P < 0.001). The VAS score at 3 days postoperatively in the experimental group (2.1 ± 0.6) was lower than that in the control group (4.3 ± 0.9) (t = 8.562, P < 0.001). The lumbar ODI index at 3 days postoperatively in the experimental group (18.3 ± 3.2) was lower than that in the control group (29.5 ± 4.1) (t = 9.215, P < 0.001). The incidence of complications in the experimental group (6.67%) was lower than that in the control group (33.33%) (χ² = 3.927, P = 0.048). There was no statistically significant difference in VAS scores (experimental group 1.2 ± 0.3 vs. control group 1.3 ± 0.4, t = 0.987, P = 0.329) and lumbar ODI index (experimental group 10.2 ± 2.1 vs. control group 10.5 ± 2.3, t = 0.452, P = 0.653) at 1 month postoperatively (P > 0.05). Conclusion: The application of the ERAS concept in PELD for LDH can accelerate the recovery process of patients, reduce early postoperative pain, speed up bed turnover, and lower the risk of complications, demonstrating significant clinical efficacy.