椎间盘镜下髓核摘除术和经皮椎间盘切吸术治疗单节段中央型椎间盘突出症的远期疗效比较

The long-term therapeutic effect of central lumbar intervertebral disc herniation:a comparison between microendoscopy discectomy and percutaneous lumbar discectomy

目的比较椎间盘镜下髓核摘除术(MED)与经皮椎间盘切吸术(PLD)治疗中央型腰椎间盘突出症的适应证、远期疗效及并发症,探讨两种术式的临床应用优势。方法回顾性分析2000年1月至2002年3月行手术治疗的单节段中央型腰椎间盘突出症患者,其中应用MED治疗23例,应用PLD治疗40例,分别比较两组手术适应证范围,病变节段,手术时间和出血量,术后卧床时间,术后住院时间,Oswestry功能障碍指数(oswestry disability index,ODI)及MacNab评分。用配对t检验κ检验及Fisher精确概率法等方法进行统计学分析。结果 MED组平均随访时间为(5.1±0.6)年,PLD组平均随访期为(6.6±0.7)年。MED组的远期ODI、MacNab评分要好于PLD组,而MED组的住院时间、住院费用则明显长于或多于后者,两组比较差异有统计学意义;远期并发症发生率分别为MED组3.49%,PLD组未出现手术相关并发症。结论 MED及PLD治疗腰椎间盘突出症均具有创伤小、恢复快、长期疗效好的特点,PLD临床普及率广,而MED相对学习曲线长,技术要求较高,手术风险较大,但MED的临床远期疗效高于PLD。

Objective To discuss the indications,long-term outcomes and complications of microendoscopy discectomy（MED） and percutanous lumbar discectomy（PLD） in treating central lumbar intervertebral disc herniation,and to compare the advantages of the two procedures.Methods During the period from Jan.2001 to March 2002 surgical procedure was carried out in sixty-three patients with single central lumbar disc herniation.The surgeries included MED（n = 23） and PLD（n = 40）.The clinical data were retrospectively analyzed.The lesion site,the operation time,the blood loss in operation,the time staying in bed,the hospitalization cost and the postoperative hospitalization days were recorded.Oswestry disability index（ODI） and MacNab score were determined.Stastical analysis was performed by using pair sample t-test,κ-test and Fisher exact test.All patients were followed up.Results A mean follow-up time was（5.1 ± 0.6） years for patients receiving MED and（6.6 ± 0.7） years for patients receiving PLD.The ODI and MacNab scores of patients receiving MED were better than these of patients receiving PLD.The hospitalization cost and the postoperative hospitalization days of MED group was higher and longer than these of PLD group,the differences between the two groups were statistically significant.The occurrence of long-term complication in MED group was 3.49%,while no complication was seen in PLD group.Conclusion For the treatment of central lumbar intervertebral disc herniation,both MED and PLD are safe and minimally-invasive procedures with satisfactory long-term effectiveness,and the patients recover from clinical symptoms quickly.The PLD has been used more common than MED.The performance of MED needs more skill and experience.Therefore,an interventional radiologist has to follow a relatively long learning curve in order to get the sufficient training and practice before he or she can master the technique of MED with full confidence.However,the long-term effect of MED for lumbar disc herniation is definitely better than that of PLD.（J Intervent Radiol,2012,21： 40-44）