后路椎间盘镜治疗腰椎间盘突出症并侧隐窝狭窄的临床疗效观察
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摘要
目的对比研究后路椎间盘镜法MED与常规经后路椎板间开窗髓核摘除术治疗腰椎间盘突出症并侧隐窝狭窄，评价腰椎间盘镜手术方法的临床疗效。观察比较应用MED及常规腰椎间盘手术病人的近、远期疗效；探讨MED适应征的扩大；对MED及常规腰椎间盘手术的优劣之处进行比较研究，最终使临床应用MED的水平得到进一步的提高。
方法首先规定纳入标准和剔除标准，从2004年10月1日—2006年10月31日期间在广州军区武汉总医院住院的患腰椎间盘突出症并侧隐窝狭窄病人中选择60例为研究对象，分为A(MED组)，B(常规组)两组，每组30人。A组30例腰椎间盘突出症并侧隐窝狭窄患者采用后路椎间盘镜法MED作为观察组，B组30例常规经后路椎板间开窗髓核摘除术治疗作为对照组，根据ODI标准评价临床疗效；同时比较两组手术各项指标包括：手术切口长度、出血量、手术时间、术后3天的体温、术后下地活动时间、住院时间、恢复正常生活学习与工作时间。所有病例于术后1周、1个月、3个月、6个月复查，以后每6个月随访一次，随访包括病人回访、电话和问卷调查等，完成对预定观察指标资料的收集。然后通过SPSS10.0进行统计学分析，两组术前术后ODI评分用t检验，ODI分级评价用Ridit检验。两组问手术切口长度、出血量、手术时间、术后3天最高体温、术后下地时间、住院时间、恢复正常生活学习和工作时间等用t检验。检验各组观察指标是否有显著差异，从而比较出两种手术之间的优缺点，最后作出进一步的分析和结论。
结果所有病例均随访3-18个月，基本收集了所有病人围手术期及术后的随访资料(A，B组分别为30人)。两组术前功能障碍指数ODI评分无显著性差异(p＞0.05)，术后6月评分两组间无显著性差异(p＞0.05)，MED组手术疗效优占86.7％，OD组手术疗效优占83.3％，两组近期疗效比较无显著性差异(p＞0.05)。两组各项指标包括手术切口长度、出血量、手术时间、术后3天的体温、术后下地活动时间、住院时间、恢复正常生活学习与工作时间等比较：MED组较常规组有显著性差异(P＜0.01)。
结论两组方法疗效相近；但后路椎间盘镜法MED创伤小，痛苦轻、恢复快、疗效佳是治疗腰椎间盘突出症并侧隐窝狭窄的较好方法，符合骨科微创的标准。MED手术具有切口小，出血少，软组织损伤轻，对腰椎的后柱结构破坏小等优点。由于手术视野放大了数倍，提高了手术安全性和疗效。经脊柱后路显微内窥镜腰椎间盘摘除术在保持神经根减压彻底的基础下，采用微创技术，损伤小，病人恢复快，疗效肯定，比常规手术有更大的优越性，因此具有广阔的应用前景。
Objective To compare Microendoscopic Discectomy(MED)with normaloperational therapy method for the treatment of lumbar discherniation(LDH) with lateral stenosis and criticize the clinical effectof MEDmethod for LDH with lateral stenosis. To observe and compareshort-time and long-time outcome in patients with microendoscopicdiscectomy or traditionally open operation, investigate how to broadenthe indications of MED and make the clinical application of MED furtherprogress by the comparison with MED and open operation.
Methods In the first place, the standards of fit and rejection wereformulated. We select sixty patients in hospital with lumbar discherniation during Oct1, 2004—Oct31,2006 and divide them into groupAand guoupB, each group having thirty patients. There were 30 cases withMED method as observed group and other 30 cases with normal method ascompared group. According to ODI's standard to evaluate the length ofincision,time on getting out of bed after surgery, time in hospital andtime on recovering normal living and working. All cases were followed upfrom a week, a month, three months and six months postoperatively. Aftersix months all patients were followed up each six months, includingrechecking, mailed, qestionnaire and so on. The data of observation werecollected almost completely. After that, all data were analyzed by SPSS10.0 in order to observe the obvious diffence between the both groups.By the above, good quality and defects between the two operations werefound, then further analysis and conclusion would be drawn.
Results All the patients were followed up from 3 to 18 months. The dataof the other were collected(groupA 30, groupB 30).The rate of excellentand good results in observed group was 86.7%,it was 83.3%in compared groupin which there was no significant stastiscal difference in the clinical effect (P＞0.05).But there was significant stastical difference betweentwo groups in the length of incision, blood lost, operative time, thehighest body temperature after operation, time on getting out of bed afteroperation, time tn hospital and time on recovering in living and working(P＜0.01).
Conclusion There was no significant for the clinical effect betweentwogroups. But MED method is better method for the treatment of LDH with withlateral stenosis because it has several advantages of minimalinvasion, shorter time of recovery, least pain and excellent effect. TheMED led to small incision, less hemorrhage, little soft tissue injury andlittle influence on the stability of the middle and posterior structureof the lumbar vertebrae. The procedure was safe and effective in a surgicalfield of magnification of several folds. Posterior spinal approachcroendoscopic discectomy for the treatment of lumbar disc herniationhas characteristics of advanced technique, minimal invasion, fastrecovery and thorough decompression to nerve roots. It has positive effectand broadly applicable future.
方法首先规定纳入标准和剔除标准，从2004年10月1日—2006年10月31日期间在广州军区武汉总医院住院的患腰椎间盘突出症并侧隐窝狭窄病人中选择60例为研究对象，分为A(MED组)，B(常规组)两组，每组30人。A组30例腰椎间盘突出症并侧隐窝狭窄患者采用后路椎间盘镜法MED作为观察组，B组30例常规经后路椎板间开窗髓核摘除术治疗作为对照组，根据ODI标准评价临床疗效；同时比较两组手术各项指标包括：手术切口长度、出血量、手术时间、术后3天的体温、术后下地活动时间、住院时间、恢复正常生活学习与工作时间。所有病例于术后1周、1个月、3个月、6个月复查，以后每6个月随访一次，随访包括病人回访、电话和问卷调查等，完成对预定观察指标资料的收集。然后通过SPSS10.0进行统计学分析，两组术前术后ODI评分用t检验，ODI分级评价用Ridit检验。两组问手术切口长度、出血量、手术时间、术后3天最高体温、术后下地时间、住院时间、恢复正常生活学习和工作时间等用t检验。检验各组观察指标是否有显著差异，从而比较出两种手术之间的优缺点，最后作出进一步的分析和结论。
结果所有病例均随访3-18个月，基本收集了所有病人围手术期及术后的随访资料(A，B组分别为30人)。两组术前功能障碍指数ODI评分无显著性差异(p＞0.05)，术后6月评分两组间无显著性差异(p＞0.05)，MED组手术疗效优占86.7％，OD组手术疗效优占83.3％，两组近期疗效比较无显著性差异(p＞0.05)。两组各项指标包括手术切口长度、出血量、手术时间、术后3天的体温、术后下地活动时间、住院时间、恢复正常生活学习与工作时间等比较：MED组较常规组有显著性差异(P＜0.01)。
结论两组方法疗效相近；但后路椎间盘镜法MED创伤小，痛苦轻、恢复快、疗效佳是治疗腰椎间盘突出症并侧隐窝狭窄的较好方法，符合骨科微创的标准。MED手术具有切口小，出血少，软组织损伤轻，对腰椎的后柱结构破坏小等优点。由于手术视野放大了数倍，提高了手术安全性和疗效。经脊柱后路显微内窥镜腰椎间盘摘除术在保持神经根减压彻底的基础下，采用微创技术，损伤小，病人恢复快，疗效肯定，比常规手术有更大的优越性，因此具有广阔的应用前景。
Objective To compare Microendoscopic Discectomy(MED)with normaloperational therapy method for the treatment of lumbar discherniation(LDH) with lateral stenosis and criticize the clinical effectof MEDmethod for LDH with lateral stenosis. To observe and compareshort-time and long-time outcome in patients with microendoscopicdiscectomy or traditionally open operation, investigate how to broadenthe indications of MED and make the clinical application of MED furtherprogress by the comparison with MED and open operation.
Methods In the first place, the standards of fit and rejection wereformulated. We select sixty patients in hospital with lumbar discherniation during Oct1, 2004—Oct31,2006 and divide them into groupAand guoupB, each group having thirty patients. There were 30 cases withMED method as observed group and other 30 cases with normal method ascompared group. According to ODI's standard to evaluate the length ofincision,time on getting out of bed after surgery, time in hospital andtime on recovering normal living and working. All cases were followed upfrom a week, a month, three months and six months postoperatively. Aftersix months all patients were followed up each six months, includingrechecking, mailed, qestionnaire and so on. The data of observation werecollected almost completely. After that, all data were analyzed by SPSS10.0 in order to observe the obvious diffence between the both groups.By the above, good quality and defects between the two operations werefound, then further analysis and conclusion would be drawn.
Results All the patients were followed up from 3 to 18 months. The dataof the other were collected(groupA 30, groupB 30).The rate of excellentand good results in observed group was 86.7%,it was 83.3%in compared groupin which there was no significant stastiscal difference in the clinical effect (P＞0.05).But there was significant stastical difference betweentwo groups in the length of incision, blood lost, operative time, thehighest body temperature after operation, time on getting out of bed afteroperation, time tn hospital and time on recovering in living and working(P＜0.01).
Conclusion There was no significant for the clinical effect betweentwogroups. But MED method is better method for the treatment of LDH with withlateral stenosis because it has several advantages of minimalinvasion, shorter time of recovery, least pain and excellent effect. TheMED led to small incision, less hemorrhage, little soft tissue injury andlittle influence on the stability of the middle and posterior structureof the lumbar vertebrae. The procedure was safe and effective in a surgicalfield of magnification of several folds. Posterior spinal approachcroendoscopic discectomy for the treatment of lumbar disc herniationhas characteristics of advanced technique, minimal invasion, fastrecovery and thorough decompression to nerve roots. It has positive effectand broadly applicable future.
引文
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