经皮内镜下腰椎间盘切除术后的硬膜外类固醇注射

Epidural Steroids After a Percutaneous Endoscopic Lumbar Discectomy.

作者信息

Shin Sang-Ha, Hwang Byeong-Wook, Keum Han-Joong, Lee Sang-Jin, Park Sang-Joon, Lee Sang-Ho

机构信息

*Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea; and †Department of Neurosurgery, Busan Wooridul Spine Hospital, Busan, Korea.

出版信息

Spine (Phila Pa 1976). 2015 Aug 1;40(15):E859-65. doi: 10.1097/BRS.0000000000000990.

DOI:10.1097/BRS.0000000000000990

PMID:25996534

Abstract

STUDY DESIGN

Randomized controlled study from a single surgeon.

OBJECTIVE

The objective of the present study is to assess the effectiveness of the administration of epidural steroids in patients who undergo a percutaneous endoscopic lumbar discectomy (PELD) because of a herniated lumbar disc.

SUMMARY OF BACKGROUND DATA

Steroids are drugs that show strong anti-inflammatory effects; in specific, the effects of epidural steroid application after an open lumbar discectomy have been studied extensively. However, no study has been conducted on the effects of perioperative epidural steroids after PELD.

METHODS

One hundred patients who had undergone a PELD because of a herniated lumbar disc were randomized into 2 groups. Patients in group 1 were subjected to an epidural steroid application after a PELD, whereas patients in group 2 were treated with saline after a PELD.

RESULTS

There was a significant decrease in visual analogue scale (VAS) scores (back, leg) and Oswestry Disability Index at all examinations (P < 0.01). When comparing the 2 groups, group 1 showed lower levels of VAS scores (back) in all examinations than group 2 but was not statistically significant (P = 0.257). In VAS score (leg), group 1 showed a significant decrease compared with the group 2 at 1 and 4 weeks of follow-up examination (P = 0.020, P = 0.032). In Oswestry Disability Index, group 1 showed a significant decrease compared with the group 2 at 1-week follow-up examination (P < 0.01).The mean hospital stay was statistically significantly shorter in group 1 (P < 0.01). The mean periods before returning to work for those who returned to work in group 1 and group 2 were 4.45 ± 3.59 weeks and 6.48 ± 4.88 weeks, respectively, when measured at follow-up at 6 months; the period in group 1 was statistically significantly shorter (P = 0.024).

CONCLUSION

Epidural steroids after a PELD reduce back pain and leg pain while improving functional outcomes in the short-term postsurgery period.

LEVEL OF EVIDENCE

摘要

研究设计

来自单一外科医生的随机对照研究。

目的

本研究的目的是评估硬膜外注射类固醇激素对因腰椎间盘突出症接受经皮内镜下腰椎间盘切除术（PELD）患者的疗效。

背景资料总结

类固醇是具有强大抗炎作用的药物；具体而言，开放性腰椎间盘切除术后硬膜外应用类固醇激素的效果已得到广泛研究。然而，尚无关于PELD围手术期硬膜外应用类固醇激素效果的研究。

方法

100例因腰椎间盘突出症接受PELD的患者被随机分为两组。第1组患者在PELD术后接受硬膜外注射类固醇激素，而第2组患者在PELD术后接受生理盐水治疗。

结果

在所有检查中，视觉模拟评分（VAS）（背部、腿部）和Oswestry功能障碍指数均显著降低（P < 0.01）。比较两组时，第1组在所有检查中的VAS评分（背部）均低于第2组，但差异无统计学意义（P = 0.257）。在VAS评分（腿部）方面，第1组在随访检查的第1周和第4周与第2组相比显著降低（P = 0.020，P = 0.032）。在Oswestry功能障碍指数方面，第1组在随访检查的第1周与第2组相比显著降低（P < 0.01）。第1组的平均住院时间在统计学上显著缩短（P < 0.01）。在6个月随访时测量，第1组和第2组中恢复工作的患者恢复工作前的平均时间分别为4.45±3.59周和6.48±4.88周；第1组的时间在统计学上显著更短（P = 0.024）。