显微镜与显微内窥镜下微创手术治疗腰椎间盘突出症的疗效比较

Comparision of surgical outcomes between microsurgical lumbar discectomy and microendoscopic dis-cectomy for lumbar disc herniation

目的:比较显微镜下腰椎间盘切除术(MSLD)与显微内窥镜下椎间盘切除术(MED)治疗单节段腰椎间盘突出症(LDH)的疗效。方法:2006年4月～2007年10月收治单节段LDH患者278例,随机分为两组,其中148例采用MSLD治疗,130例采用MED治疗。比较两种手术的切口长度、手术时间、并发症、住院天数,手术后VAS、SF-36量表躯体疼痛评分、ODI改善率和改良MacNab评分情况。结果:MSLD组及MED组的切口长度分别为4.5±1.5cm和2.5±0.8cm,手术时间分别为40.0±13.8min和56.0±15.9min,两组间均有显著性差异(P<0.05);术中出血量分别为96±77ml和111±45ml、住院天数分别为9.4±2.6d和9.8±2.8d,两组间均无显著性差异(P>0.05)。MSLD组及MED组随访时间分别为平均18.3个月和18个月,末次随访时MSLD组及MED组的VAS改善率分别为(85.3±1.8)%和(84.5±2.1)%,SF-36量表躯体疼痛评分改善率分别为(81.3±5.6)%和(80.1±6.1)%,ODI改善率分别为(85.3±1.8)%和(82.3±2.0)%,改良MacNab评分优良率分别为94.0%和93.7%,两组间比较均无显著性差异(P>0.05)。MSLD组及MED组并发症分别为:腹部不适14例(9.46%)和12例(9.23%)、急性尿潴留21例(14.19%)和18例(13.84%),两组比较均无显著性差异(P>0.05);硬脊膜撕裂0例和2例(1.54%)、急性竖脊肌血肿2例(1.36%)和5例(3.85%),MSLD组明显少于MED组(P<0.01)。结论:MSLD与MED治疗单节段腰椎间盘突出症均可取得满意疗效,但MSLD操作简便、并发症少,是目前更为理想的微创手术方法。

Objective：To evaluate the effectiveness of mierosurgical lumbar diseectomy（MSLD） and microendoscopie disceetomy （MED） for lumbar disc herniation （LDH）.Method：A prospective clinical review was conducted on the two minimal invasion surgical methods for single segment LDH from April 2006 to October 2007,one group of 148 patients who underwent MSLD and the other of 130 patients who underwent MED.The factors considered included the length of skin incision,the operative time,amount of intraoperative bleeding, duration of hospitalization,dose of analgesic agent used after surgery,pre- and postoperative assessment based on the criteria of visual analog scales （VAS）,the bodily pain of SF-36,the Oswestry disability index （ODI） and modified MacNab scores.Result：The mean length of skin incision was 4.5±1.5em and 2.5±0.8cm for MSLD and MED respectively with the latter a little bit shorter than the former （P〈0.05）.The operative time was 40.0±13.8min and 56.0±15.9min for MSLD and MED respectively,with the latter obviously longer than the former（P〈0.05）.The blood loss was 96±77ml and 111±45ml and hospitalization time was 9.4±2.6 days and 9.8±2.8 days for MSLD and MED respectively,which had no significant difference （P〉0.05）.The follow-up VAS score was （85.3±1.8）% and （84.5±2.1）% for MSLD and MED respectively,the bodily pain of SF-36 was （81.3±5.6）% and （80.1±6.1）% for MSLD and MED respeetively,ODI was （85.3±1.8）% and （82.3±2.0）% for MSLD and MED respectively,and the total excellent to good ratio of modified MacNab score was 94.0% and 93.7% for MSLD and MED respectively,all showed no significant difference （P〉0.05）.As for the complications in two groups：the incidence of abdominal discomfort was 14 cases （9.46%） and 12 cases （9.23%）,acute urinary retention was 21 （14.19%） and 18 （13.84%） for MSLD and MED respectively,all showed no significant difference （P〉0.05 ）.Dural tear occurred in 0 case and 2 cases（1.54%）,acute hematomas of sacrospinalis occurred in 2 cases （1.36%） and 5 cases （3.85%） for MSLD and MED respectively,with MSLD lower than MED （P〈0.01） .Conclusion：The clinical effects of both minimal invasive methods are satisfactory,with MSLD having advantages of simpler maneuvering and less complications,as a result,MSLD is the ideal method of discectomy.