富血小板血浆在经皮内镜椎间盘切除术的应用

Effect of platelet-rich plasma on outcomes of percutaneous transforaminal endoscopic discectomy

摘要:

［目的］分析经皮椎间孔镜椎间盘切除术（percutaneous transforaminal endoscopic discectomy, PTED）中注射富血小板血浆 （platelet rich plasma, PRP） 对临床疗效的影响。［方法］ 2019 年 1 月—2019 年 12 采用 PTED 治疗单纯腰椎间盘突出症患者 73 例。依据术前医患沟通结果，PRP 组 36 例，手术结束时椎间盘内及神经根周围注射 PRP 液 5 ml+凝血酶溶液 2 ml（40 U/ ml）；无 PRP 组 37 例，仅行单纯 PTED 术。比较两组围术期、随访和影像资料。［结果］所有患者均顺利完成手术，两组术中并发症发生率比较差异无统计学意义（P=0.071）。两组手术时间、切口总长度、术中失血量 、下地行走时间、切口愈合等级、住院时间及 VAS 评分的差异均无统计学意义（P>0.05）。两组患者平均随访时间（15.37±1.92）个月，随时间推移，两组 VAS 评分、 ODI 评分均显著降低（P<0.05）；术后 1 个月 PRP 组 VAS 评分显著优于无 PRP 组（P<0.05），术后 6 个月和末次随访时，PRP 组的 ODI 评分显著优于无 PRP 组（P<0.05）。影像方面，随时间推移，两组椎间隙高度指数均显著减少（P<0.05）。末次随访时 PRP 组的椎间隙高度指数显著优于无 PRP 组（P<0.05）。随时间推移，两组手术间隙 Pfirrmann 分级无显著变化（P>0.05）。末次随访时 PRP 组椎间盘 Pfirrmann 分级显著优于无 PRP 组（P<0.05）。［结论］ PTED 术中注射 PRP 可能有利于纤维环的修复，延缓椎间隙退变，改善临床治疗效果。

Abstract:

[Objective] To explore the effect of platelet-rich plasma (PRP) in percutaneous transforaminal endoscopic discectomy (PT- ED) on clinical outcomes. [Methods] From January 2019 to December 2019, 73 patients underwent PTED fro simple lumbar disc hernia- tion. According to the preoperative doctor-patient communication results, 36 patients in PRP group were injected PRP 5ml combined with thrombin 2ml (40 U/ml) in intervertebral disc and around nerve roots at the end of surgery, while the other 37 patients in the non-PRP group had PTED performed alone. The Perioperative, follow-up and imaging data of the two groups were compared. [Results] All the pa- tients in both groups were successfully operated on, without significant difference in the incidence of intraoperative complications between the two groups (P=0.071) . There were no significant differences in operative time, total incision length, intraoperative blood loss, postoper- ative walking time, incision healing, hospital stay and early VAS score between 2 groups (P＞0.05) . With time of follow- up lasted for (15.37±1.92) months, the VAS and ODI scores decreased significantly in both group (P＜0.05) . However, the PRP group proved signifi- cantly superior to the non-PRP group in VAS score 1 month postoperatively (P＜0.05) , and the ODI score at 6 months and the last followup (P＜0.05) . Radiographically, the intervertebral height index decreased significantly over time in both groups (P＜0.05) , which in the PRP group was significantly superior to the non-PRP group at the last follow-up (P＜0.05) . No significant change was noted over time in term of Pfirrmann classification for disc degeneration between two groups (P＞0.05) . At the latest follow-up, the PRP group proved signifi- cantly superior to the non-PRP group in term of Pfirrmann grading of intervertebral discs degeneration (P＜0.05) . [Conclusion] Intraopera- tive injection of PRP in PTED might be beneficial to the repair of annulus fibrosus, delay intervertebral degeneration and improve clinical outcomes.