椎间孔镜联合富血小板血浆治疗椎间盘源性腰痛△

Percutaneous transforaminal endoscopic discectomy combined with platelet-rich plasma for discogenic low back pain

摘要:

[目的] 观察椎间孔镜 (percutaneous transforaminal endoscopy discectomy, PTED) 联合富血小板血浆 (platelet-rich plasma, PRP)治疗椎间盘源性腰痛(discogenic low back pain, DLBP)的临床疗效。[方法]将 36 例 DLBP 患者随机分为 PRP 组与非 PRP 组，每组 18 例，PRP 组给予 PTED 联合 PRP 治疗，非 PRP 组给予单纯 PTED 手术治疗，比较两组围手术期、随访及影像结果。[结果]两组手术均顺利完成，两组手术时间、术中透视次数、术中失血量、住院时间的差异均无统计学意义(P＞ 0.05)，未出现严重不良反应及并发症。随访 12 个月以上，PRP 组恢复完全负重活动显著早于非 PRP 组 (P＜0.05)。术后随时间推移，两组 VAS 评分、ODI 指数均显著减少 (P＜0.05)，而 JOA 评分显著增加 (P＜0.05)；术前、术后 3 个月两组间上述评分的差异均无统计学意义(P＞0.05)，术后 12 个月，PRP 组上述评分均显著优于非 PRP 组(P＜0.05)。影像方面，术后 12 个月 PRP 组椎间隙高度及椎间盘 Pfirrmann 分级均显著优于非 PRP 组 (P＜0.05)。[结论] PTED 联合 PRP 治疗 DLBP 安全有效，可有效缓解疼痛，并有一定的延缓间盘退变的作用。

Abstract:

[Objective] To evaluate the clinical outcomes of percutaneous transforaminal endoscopic discectomy (PTED) combined with platelet-rich plasma (PRP) for discogenic low back pain (DLBP). [Methods] A total of 36 patients with DLBP were randomly divided into PRP group and non-PRP group with 18 cases in each group. The PRP group was treated with PTED combined with intradiscal injec- tion of PRP, while the non-PRP group received PTED only. The perioperative, follow-up and imaging documents were compared between the two groups. [Results] All patients in both groups had corresponding surgical procedures performed smoothly without significant differ- ences in terms of operation time, intraoperative fluoroscopy times, intraoperative blood loss and hospital stay between the two groups (P＜ 0.05), without serious adverse reactions and complications in both groups. All of them were followed up for more than 12 months, and the PRP group resumed full weight-bearing activity significantly earlier than the non-PRP group (P＜0.05). The VAS score for pain and ODI score significantly decreased (P＜0.05), while JOA score significantly increased in both groups over time (P＜0.05), which was not significant- ly different between the two groups before surgery and 3 months after surgery (P＞0.05), while in the PRP group proved significantly superi- or to those in the non-PRP group at 12 months postoperatively (P＜0.05). With respect of imaging, the PRP group also proved significantly superior to the non-PRP group in terms of the disc height and Pfirrmann grades of involved intervertebral space 12 months postoperatively (P＜0.05). [Conclusion] PTED combined with PRP is a safe and effective method for the treatment of DLBP, which can effectively relieve pain and might delay intervertebral disc degeneration to a certain extent.