经皮椎间孔镜术中应用复方倍它米松的作用与风险研究
Clinical Observation of Methylprednisolone in Nerve Roots Irritation after Percutaneous Transforaminal Endoscopic Discectomy
摘要: 目的：观察腰椎间孔镜术中应用复方倍它米松对保护脊髓功能，促进术后神经功能恢复的作用及其风险研究。方法：对2013年12月至2014年12月接受经皮椎间孔镜下髓核摘除术的60例单节段脱出型腰椎间盘突出症患者进行前瞻性随机对照研究，男31例，女29例；年龄19~71岁，平均40.0 (间盘突出)岁；L3/4共9例，L4/5共31例，L5/S1共20例。按随机数字表中随机数的奇数和偶数随机分为A组和B组，每组30例。A组为单纯经皮椎间孔镜下髓核摘除术，B组行经皮椎间孔镜下髓核摘除术后明胶海绵浸润1 mL复方倍他米松覆盖于出口根及硬膜囊腹侧，术前、术后即刻、术后1 d、术后3 d、术后30 d及术后90 d随访时采用视觉模拟评分法(Visual Analogue Scale, VAS评分)及腰椎功能障碍指数(Oswestry Disability Index, ODI评分)评估患者术后腰腿痛程度。结果：因失访、需要其它复杂治疗等原因3例被排除，其余57例病人中，A组28例，B组29例。术后即刻、第1、3 d VAS疼痛评分：AA组(3.01  1.06)分，(2.83  0.87)分，(2.04  0.46)分；B组：(2.13  0.84)分，(1.75  0.68)分，(1.07  0.24)分，两组比较差异有统计学意义(p < 0.05)；ODI评分：A组(11.0  2.46)分，(9.83  2.38)分，(9.05  1.98)分；BB组：(5.02  0.98)分，(4.86  0.86)分，(3.26  0.53)分；两组比较差异有统计学意义(P < 0.05)。术后第30 d、90 d VAS疼痛评分、ODI评分，比较差异均无统计学意义(P > 0.05)。结论：经皮腰椎间孔镜术中应用复方倍它米松可有效改善椎间孔镜下髓核摘除术后神经根刺激症状，但术后30 d后恢复效果与应用复方倍它米松无关，同时应用复方倍它米松也没有增加感染等并发症的风险。
Abstract: Objective: To observe the effect of compound betamethasone on the protection of spinal cord function and the recovery of neurological function after lumbar intervertebral fluoroscopy. Methods: A prospective randomized controlled study was conducted in 60 patients with single-segment prolapse of lumbar disc herniation who underwent percutaneous lumbarectomy from December 2013 to December 2014. There were 31 males and 29 females in patients with lumbar disc herniation: aged 19 to 71 years, mean (40.0 ± 11.4) years; L3/4 in 9 cases, L4/5 in 31 cases, L5/S1 in 20 cases. The patients were randomly divided into group A and group B, with 30 patients in each group. Group A was treated with pure percutaneous nucleus pulposus, and group B was treated with 1 mL compound betamethasone after percutaneous lumbar intervertebral foraminectomy. The visual analogue scale (VAS score) and Oswestry Disability index (ODI score) were performed at preoperative, postoperative immediately, 1 day, 3 days, 30 days and 90 days after operation to assess the degree of postoperative low back pain. Results: Due to loss of visits, the need for other complex treatment and other reasons, 3 cases were excluded, with the remaining 57 patients, A group of 28 cases, B group of 29 cases. At postoperative immediately, 1 day, 3 days after operation, VAS score in group A was (3.01 ± 1.06), (2.83 ± 0.87), (2.04 ± 0.46), respectively. Meanwhile, in group B that was (2.13 ± 0.84), (1.75 ± 0.68), (1.07 ± 0.24), respectively. The difference between the two groups was statistically significant (p < 0.05); ODI score in group A was (11.0 ± 2.46), (9.83 ± 2.38), (9.05 ± 1.98), respectively. Meanwhile, in group B that was (5.02 ± 0.98), (4.86 ± 0.86), (3.26 ± 0.53). The difference between the two groups was statistically significant (P < 0.05). There was no significant difference in VAS pain score and ODI score at 30 days and 90 days after operation (P > 0.05).
文章引用：李波, 陈静, 李新志, 阙祥勇, 李意, 田青松, 陈文瑶, 朱天波. 经皮椎间孔镜术中应用复方倍它米松的作用与风险研究[J]. 亚洲外科手术病例研究, 2018, 7(2): 10-16. https://doi.org/10.12677/ACRS.2018.72003

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