椎间盘镜法与手术后路减压法治疗腰神经根管狭窄症的疗效比

Comparison of techniques for decompressive lumbar laminectomy:microendoscopic discectomy versus the"classic"open approach

目的对比后路椎间盘镜(MED)与开放入路腰椎板切除减压治疗腰神经根管狭窄症的手术疗效,为临床提供经验参考和治疗依据。方法 2004年10月-2008年10月,收治腰椎管狭窄症患者170例,(A组)83例患者通过后路椎间盘镜对受压神经根减压;(B组)87例患者通过标准开放技术进行减压。结果两组均顺利完成手术,采用北美脊柱外科学会的腰椎功能障碍指数评定疗效,两组优良率比较差异无统计学意义(P>0.05)。A组较B组患者手术时间短,住院时间短,估计失血量少。结论 MED与传统开放手术疗效相近,且克服了传统开放手术存在的缺陷,创伤小,并发症少、轻微,术后可早期活动等优点。是值得推荐的手术方法。

Objective To compare microendoscopic discectomy（MED） with open discectomy（OD） for degenerative lumbar spinal stenosis in terms of clinical outcomes,provide experience and therapeutic evidence for clinical application.Methods From October 2004 to October 2008,170patients with lumbar spinal stenosis were randomized into two groups,and underwent either MED or OD.In group A,83patients underwent MED,In group B,87patients received OD.Results Operations were successfully performed in all cases.Therapeutic effect was evaluated by Oswestry disability index of The North American Spine Society standard.there was no significant difference between two groups（P0.05）.Conclusion Two methods have the similar therapeutic effect,but MED eliminates the shortcomings of traditional OD,less trauma shorter operative times and less blood loss,less muscle dissection,fewer and less severe complications,and better mobility in the immediate postoperative period than open decom-pressive techniques.so it is surgical technique worth to be recommend.