极外侧型腰椎间盘突出症显微内镜手术与开放手术治疗的比较

Comparison between microendoscopic surgery and open surgery for far lateral lumbar disc herniation

目的比较显微内镜手术和开放手术治疗极外侧型腰椎间盘突出症,评价显微内镜手术方式的临床价值。方法对36例极外侧型腰椎间盘突出症手术患者进行回顾性比较研究。16例接受显微内镜手术,平均年龄42.6岁(35～60岁)。20例经开放手术,平均年龄45.5岁(30～64岁)显微内镜手术分别采用经椎板间隙入路、经关节突入路和经横突间入路,在内镜下完成神经根探查、减压和椎间盘髓核摘除。开放手术采用经椎板间隙入路和经横突间入路,进行神经根减压和椎间盘髓核摘除。结果显微内镜手术组平均随访8.3个月,平均手术时间78min,平均术中失血68ml,平均住院日13.8d。开放手术组平均随访14个月,平均手术时间74min,平均术中失血95ml,平均住院日16.5d。显微内镜手术组手术后切口疼痛轻,镇痛治疗显著少于开放手术组。采用改良MacNab标准评价随访结果,显微内镜手术组12例患者达优,3例良,1例可。开放手术组14例患者达优,4例良,2例可。结论显微内镜手术治疗极外侧型腰椎间盘突出症,与开放手术比较有相似的近期临床效果,但具有切口小、组织损伤轻和恢复较快的特点,能够尽可能维持腰椎稳定。

Objective: To complete the comparison between microendoscopic surgery and open surgery for far lateral lumbar disc herniation, and to assess the clinical value of microendoscopic surgery.Method: In a retrospective study, 16 patients suffering from far lateral lumbar disc herniation were treated with microendoscopic surgery, and a second group of 20 patients treated with open surgery was used for comparison. Mean age at microendoscopic surgery group was 42.6 years (ranged 35～60), 45.5 years (ranged 30～64) at open surgery group. The microendoscopic surgery was performed via vertebral lamina gap approach,zygapophyseal approach and intertransverse processes approach respectively.Thorough root exploration, direct decompression and removal of disc material were performed by endoscope. The open surgery was completed via vertebral interlaminal approach and intertransverse processes approach. Result: At follow-up (mean of 8.3 months for microendoscopic surgery group and 14 months for open surgery group),the results for microendoscopic surgery group were as follows: mean operative time,78 minutes. Average blood loss, 68ml. Mean hospital stay, 13.8 days. The results for open surgery group were as follows: mean operative time, 74 minutes. Average blood loss, 95ml. Mean hospital stay, 16.5 days. The microendoscopic surgery group needed significantly less narcotic medication after surgery. The follow-up outcomes were determined using a modified MacNab criteria, which revealed that 12 patients had excellent, 3 good, 1 fair in microendoscopic surgery group. Fourteen patients had excellent, 4 good, 2 fair outcomes in open surgery group.Conclusion: Compared with open surgery, microendoscopic surgery for far lateral lumbar disc herniation appears offering a similar short-term clinical outcome with a smaller incision, less tissue trauma and quicker recovery. Microendoscopic surgery may maintain lumbar stability as well as possible.