Department of Orthopaedics, Zhongshan Torch Development Zone People's Hospital, Zhongshan, 528437, Guangdong, China.
Department of General surgery, Zhongshan Torch Development Zone People's Hospital, Zhongshan, 528437, Guangdong, China.
J Orthop Surg Res. 2024 Oct 15;19(1):655. doi: 10.1186/s13018-024-05153-5.
This study investigates the clinical efficacy and safety of percutaneous endoscopic nucleotomy combined with platelet-rich plasma (PRP) injection in treating lumbar disc herniation (LDH) in young and middle-aged adults.
From April 2022 to September 2023, 60 patients diagnosed with LDH were randomly divided into two groups (n = 30/group). The observation group underwent percutaneous endoscopic nucleotomy combined with autologous PRP gel injection into the disc, while the control group underwent percutaneous endoscopic nucleotomy alone. Visual Analogue Scale (VAS) scores and Oswestry Disability Index (ODI) scores were recorded preoperatively and at three time points postoperatively: three days, three months, and six months. The modified Macnab criteria were employed to evaluate efficacy at the final follow-up. Additionally, MRI Pfirrmann grading of the operated disc segment and potential complications were assessed both preoperatively and at the final follow-up.
All patients were followed for a minimum of six months. VAS and ODI scores at all postoperative time points (three days, three months, and six months) exhibited significant differences compared to preoperative scores in both groups (P < 0.05). Notably, a significant difference was observed in VAS and ODI scores between the two groups at three days postoperatively (P < 0.05). Preoperative MRI Pfirrmann grading indicated no significant difference between groups (P = 0.669). However, at the final follow-up, the observation group demonstrated superior recovery compared to the control group (P = 0.013). The modified Macnab criteria revealed no significant difference in the rates of excellent and good outcomes between the observation group (96.67%) and the control group (93.33%) (P > 0.05). Furthermore, no patients experienced complications such as dural tears, nerve root injury, infection, or hematoma.
The combination of percutaneous endoscopic nucleotomy and PRP injection could be a safe and effective treatment for LDH in young and middle-aged adults to promote disc repair following endoscopic procedures.
本研究旨在探讨经皮内镜下髓核切除术（PELD）联合富血小板血浆（PRP）注射治疗中青年腰椎间盘突出症（LDH）的临床疗效和安全性。
2022 年 4 月至 2023 年 9 月，将 60 例 LDH 患者随机分为两组（n=30/组）。观察组采用 PELD 联合椎间盘内自体 PRP 凝胶注射治疗，对照组仅采用 PELD 治疗。分别于术前和术后 3 天、3 个月、6 个月记录视觉模拟评分（VAS）和 Oswestry 功能障碍指数（ODI）评分。末次随访时采用改良 Macnab 标准评价疗效。同时，分别于术前和末次随访时评估手术节段 MRI Pfirrmann 分级和潜在并发症。
所有患者均获得至少 6 个月的随访。两组患者术后各时间点（3 天、3 个月、6 个月）VAS 和 ODI 评分均较术前显著降低（P<0.05）。术后 3 天，两组间 VAS 和 ODI 评分差异有统计学意义（P<0.05）。术前 MRI Pfirrmann 分级两组间差异无统计学意义（P=0.669）。末次随访时，观察组恢复情况优于对照组（P=0.013）。改良 Macnab 标准评价优良率观察组（96.67%）与对照组（93.33%）差异无统计学意义（P>0.05）。两组均未出现硬脊膜撕裂、神经根损伤、感染、血肿等并发症。
PELD 联合 PRP 注射治疗中青年 LDH 安全有效，可促进内镜术后椎间盘修复。
