摘要
目的：比较椎间盘镜下髓核摘除术和传统椎板开窗髓核摘除术治疗单节段腰椎间盘出症的近、中期疗效及优缺点。
方法：回顾性分析2001年1月～2005年12月手术治疗的单节段椎间盘突出症患者476例,其中应用椎间盘镜手术治疗腰椎间盘突出症患者215例、传统开窗开窗手术261例。两组各随机抽取50例,分别比较手术切口长度、手术时间、出血量、术后三天平均体温、术后卧床时间以及术后住院时间、术前术后JOA评分、腰痛及腿痛VAS评分。
结果：椎间盘镜组和传统椎板开窗组疗效优良率分别为98%和96%,无显著性差异,同时两组患者术后腿痛缓解无显著性差异；而两组患者在术后腰痛的VAS评分、手术切口长度、术中出血量、术后卧床时间、住院天数两组比较有显著性差异,椎间盘镜组要明显优于传统椎板开窗组。
结论：两种术式都能有效缓解腰椎间盘突出症患者的症状,MED手术创伤小、出血少、术后早期康复快,术后遗留腰痛较轻,但手术适应证相对狭窄,尚不能完全替代传统椎板开窗手术。
Objective:To compare the Medium-term and short-term efficacy, advantages and disadvantages of the mono-segment lateral lumbar disc herniated patients with the treatment of microendoscopic discectomy and fenestration discectomy.
Methods:476 cases operated with mono-segment discectomy were analyzed from January 2001 to December 2005, among them, 215 cases operated with microendoscopic discectomy and 261 cases operated with fenestration discectomy.Were randomly selected 50 cases in two group, the length of surgical incision, the operating time, blood loss, the average temperature for three days after surgery, time stay-in-bed, duration of hospitalization after operation, preoperative and postoperative JOA score, low back pain and leg pain VAS score were compared.
Results:The rate of excellent and good outcomeswas 98% in MED group, and 96% in fenestration discectomy group, no significant difference was found between them, and the same with the postoperative sciatica relief.Significant differences ould be observed in the postoperative Low back pain VAS score, the length of surgical incision, blood loss, time stay-in-bed and duration of hospitalization after operation.
Conclusion:The symptoms of the lumbardisc herniation can be reliefed effectively by both methods, but microendoscopic discectomy has more advantages of less trauma, less bloodloss, earlier rehabilitation, less postoperative low back pain, but relatively narrow operative indication, still not a perfect substitute for fenestration discectomy.
引文
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