微创显微腰椎间盘切除术的初步疗效评价

Evaluation of the primary outcomes of minimally invasive lumbar microdiscectomy

目的评价微创显微腰椎间盘切除术初步疗效。方法对单间隙腰椎间盘突出症接受管道扩张微创入路（METRx系统）显微腰椎间盘切除术（微创组）与传统手术（传统组）各34例，比较两组手术时间、术中出血量、术后下地时间与住院时间。视觉模拟评分（VAS）评价术后伤口疼痛。改良MacNab法评价疗效。结果平均手术时间：微创组65min，传统组63min。术中平均出血量：微创组34ml，传统组85ml。两组比较差异有统计学意义（P〈0．05）。术后平均实际下地时间微创组2．6d，传统组5．8d；术后平均住院时间：微创组5．8d，传统组9．6d；术后伤口疼痛平均VAS评分：微创组3．2分、传统组5．6分。两组比较差异有统计学意义（P〈0．05）。并发症微创组1例，传统组4例；微创组33例获得平均8．5个月随访，优良率为93．9％，术后1例复发再次手术。结论微创显微腰椎间切除术具有创伤小、安全、康复快的优点，能取得满意的疗效。

Objective To evaluate the primary outcomes of minimally invasive lumbar microdiscectomy. Methods There were 34 cases with single lumbar disc herniation treatment of tubular retractor access with METRx system and microdiscectomy （MMD group） and same cases with treatment of conventional discectomy （CD group）. Operating time, blood loss, time of leaving the bed and length of hospital stay were compared in two groups. The postoperative wound pain was measured using a visual analog scale （VAS）. The modified MacNab criteria were used to evaluate the outcomes. Results The mean operating time was 65 min in MMD group, 63 min in CD group. The mean blood loss was 34 ml in MMD group, 85 ml in CD group. To compare in two groups, there was significant difference （P 〈 0.05）. The mean time of leaving the bed after operation was 3.2 d in MMD group, 5.8 d in CD group. The mean length of hospital stay was 5.8 d in MMD group, 9.6 d in CD group. The mean VAS of the postoperative wound pain was 3.2 scores in MMD group, 5.6 scores in CD group. To compare in two groups, there was significant difference （P 〈0.05）. There was one complication in MMD group, 4 in CD group. Thirty-three cases got follow-up mean 8.5 months in MMD group. The success rate was 93.9%. Conclusion The minimally invasive lumbar microdiscectomy has the advantages on less trauma, safety, quickly postoperative recovery, and satisfactory outcomes.