显微内镜腰椎间盘髓核摘除术与开放手术的比较研究

Comparative Study on Microendoscopic Lumbar Discectomy and Open Surgery

目的比较显微内镜腰椎间盘髓核摘除术(MED)和标准开放手术,评价MED的临床价值.方法对120例腰椎间盘突出症手术患者进行回顾性比较研究.60例接受MED,平均年龄35.6岁(26～62岁).同期60例经开放手术,平均年龄46.5岁(23～78岁).MED采用旁正中小切口,在内镜下完成神经根探查、减压和椎间盘髓核摘除.开放手术采用标准的经椎板间隙开窗、神经根减压和椎间盘髓核摘除.结果MED组平均随访13.5个月,单节段手术时间75 min,失血40 ml,术后卧床48 h.开放手术组平均随访15个月,手术时间60 min,失血90 ml,术后卧床168 h.MED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标准评定随访结果:优77%,良20%,可3%.开放手术组症状改善情况与MED组相似.结论同标准开放手术比较,MED表现相似的短期临床效果,但具有切口小、组织损伤轻和恢复较快的特点.

Objective To have a comparison between microendoscopic discectomy (MED) and standard open discectomy,and assess the clinical value of MED. Methods In a retrospective study,60 patients treated with MED and 60 patients treated w ith standard open discectomy was used for the comparison.The mean age were 35.6 years (ranged 26～62) and 46.5 years (ranged 23～78) respectively in MED group and standard open surgery group.MED was performed via a small paracentral approach that allows thorough root exploration,direct decompression and remove of disc material.This was achieved by applying open surgical tools through a tubula r retractor under endoscopic visualization.The endoscope was inserted by a sequent ial set of dilators passed over the initial guide wire. Results The two groups were followed up for 13.5 months 15 months separately.The results of MED group were as follow s: operative time,75 minutes per single level;blood loss,40ml;postoperative sta y,48 hours.The results of the standard open surgery group were as follows:operative time, 60 minutes;blood loss,90 ml;postoperative stay,168 hours.MED group needed significantly less narcotic medication after surgery.The fellow_up outcomes wer e evaluated using a modified MacNab criteria,which revealed that 77% of patients were excellent,20 % were good,3 % were fair in MED group.The open group was similar. Conclusion Compared with the standard open surgery group,MED offer a similar short_term clinical outcome,but with smaller incision,less tissue trau ma and quicker recovery.