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经皮内镜下腰椎间盘切除术联合富血小板血浆注射治疗腰椎间盘突出症：临床及影像学结果分析

Percutaneous endoscopic lumbar discectomy combined with platelet-rich plasma injection for lumbar disc herniation: analysis of clinical and imaging outcomes.

作者信息

Li Tusheng, Du Wei, Ding Zhili, Liu Jiang, Ding Yu

机构信息

Orthopedics of TCM Senior Dept, The Sixth Medical Center of PLA General Hospital, Beijing, People's Republic of China.

出版信息

BMC Musculoskelet Disord. 2024 Apr 24;25(1):328. doi: 10.1186/s12891-024-07444-8.

DOI:10.1186/s12891-024-07444-8
PMID:38658984
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11044406/
Abstract

OBJECTIVE

To evaluate the clinical efficacy and imaging outcomes of percutaneous endoscopic lumbar discectomy (PELD) combined with platelet-rich plasma (PRP) for the treatment of lumbar disc herniation (LDH).

METHODS

A total of 155 patients with LDH between January 2020 and June 2022 were retrospective analyzed, of which 75 underwent PELD with PRP and 80 underwent PELD only. Clinical functional scores and imaging data were compared. Clinical functional scores included visual analog scale of leg pain (VAS-LP) and back pain (VAS-BP), Japanese Orthopedic Association score (JOA), Oswestry Disability Index (ODI) and modified MacNab criteria. Imaging data included disc height index (DHI), spinal cross-sectional area (SCSA), disc protrusion size (DPZ), and ratio value of disc grey scales (RVG).

RESULTS

Both groups showed clinical improvement, and VAS-LP, VAS-BP, JOA and ODI were significantly improved in the PRP group compared with the control group at 3, 6 and 12 months postoperatively (P < 0.05). At the last follow-up, the differences in SCSA, DPZ and RVG between the two groups were statistically significant (P < 0.05), with the PRP group being superior to the control group. The excellent and good rates of the modified Macnab criteria in the PRP group and control group were 93.3% and 90%, respectively, with no statistically significant difference (P > 0.05). No serious complications occurred during the follow-up period.

CONCLUSION

PELD combined with PRP is a safe and effective method for treating patients with LDH. PRP injection was beneficial for delaying disc degeneration and promoting disc remodeling.

摘要

目的

评估经皮内镜下腰椎间盘切除术（PELD）联合富血小板血浆（PRP）治疗腰椎间盘突出症（LDH）的临床疗效及影像学结果。

方法

回顾性分析2020年1月至2022年6月期间共155例LDH患者，其中75例行PELD联合PRP治疗，80例仅行PELD治疗。比较两组的临床功能评分及影像学数据。临床功能评分包括腿痛视觉模拟量表（VAS-LP）、背痛视觉模拟量表（VAS-BP）、日本骨科协会评分（JOA）、Oswestry功能障碍指数（ODI）及改良MacNab标准。影像学数据包括椎间盘高度指数（DHI）、脊柱横截面积（SCSA）、椎间盘突出大小（DPZ）及椎间盘灰度比值（RVG）。

结果

两组患者临床均有改善，术后3、6及12个月时，PRP组的VAS-LP、VAS-BP、JOA及ODI较对照组均有显著改善（P＜0.05）。末次随访时，两组间SCSA、DPZ及RVG差异有统计学意义（P＜0.05），PRP组优于对照组。PRP组和对照组改良MacNab标准的优良率分别为93.3%和90%，差异无统计学意义（P＞0.05）。随访期间未发生严重并发症。

结论

PELD联合PRP是治疗LDH患者的一种安全有效的方法。PRP注射有利于延缓椎间盘退变并促进椎间盘重塑。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8973/11044406/e37cd520118e/12891_2024_7444_Fig9_HTML.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8973/11044406/e37cd520118e/12891_2024_7444_Fig9_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8973/11044406/6d234c886ed9/12891_2024_7444_Fig1_HTML.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8973/11044406/dc758779fc0f/12891_2024_7444_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8973/11044406/a54dca525836/12891_2024_7444_Fig7_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8973/11044406/07d83c787867/12891_2024_7444_Fig8_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8973/11044406/8adc0207cad0/12891_2024_7444_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8973/11044406/1740e0bafa3a/12891_2024_7444_Fig6_HTML.jpg
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