腰椎间盘突出症三种治疗方法的回顾性研究

A COMPARATIVE STUDY OF THREE DIFFERENT THERAPIES FOR LUMBAR DISC HERNIATION

目的 :对后路显微内窥镜下髓核摘除术 (MED组 )、后路开窗髓核摘除术 (Love组 )及胶原酶化学溶盘术 (CCNL组 )治疗腰椎间盘突出症的方法和疗效进行回顾性研究。方法 :采用统一的病例选择和疗效评定标准 ,对 2 37例患者 (其中MED组 87例 ,Love组 6 5例 ,CCNL组 85例 )进行分析 ,比较三组术后近、中期日本骨科协会 (JOA) 2 9分法评分及优良率 ,同时比较MED组和Love组病人围手术期有关情况。结果 :(1)MED组术后近、中期JOA评分及优良率高于Love组 ,但无统计学差异 ;(2 )CCNL组近、中期JOA评分及优良率均低于MED和Love组 ,差异显著 (P <0 .0 0 1) ;(3)术后中期与近期JOA评分比较 ,MED组和Love组有所提高 (P <0 .0 0 1) ,而CCNL组则略有下降 (P >0 .0 5 ) ;(4 )MED组在手术切口长度、术中出血量、术后引流量和卧床时间等方面均优于Love组 (P <0 .0 0 1)。结论 :在治疗腰椎间盘突出症的三种方法中 ,MED手术较Love法创伤更小 ,恢复更快 ,较CCNL术疗效更好。但CCNL术也有方法简单方便 ,基本无创的优点。

Objective: To compare the method and effectiveness of treatment for lumbar disc herniation with posterior microendoscopic discectomy (MED group),Love method (Love group ) and collagenase chemonucleolysis (CCNL group). Method: With the unified diagnosis criterion for evaluation of curative effect,237 patients (87 in the MED group,65 Love group and 85 CCNL group) were analyzed. The short and mid-term follow-up information of three groups,and perioperation issue of MED and Love groups were compared. Results: (1)The JOA scores of short and mid-term postoperation,and the excellent and good rate of the patients in MED group were higher than those of Love group,but there was no significant difference. (2) The JOA scores of near-and mid-term postoperation of CCNL group were significantly lower than those of MED and Love groups ﹙ P <0.001). (3)Comparing JOA scores of mid-term with short term postoperation,MED and Love groups rise ﹙ P <0.001) and CCNL group drop somewhat ( P > 0.05). (4)The length of incision,blood loss during and after operation,and time in bed of the patients in MED group was better than those of Love group ( P <0.001) . Conclusion: MED method has advantages of less injury and shorter time recovery than Love method,more effective than CCNL. But CCNL has some advantages including method simple,not wound basically.