小切口减压治疗腰椎间盘突出症的临床疗效

The clinical effects of the decompression with small incision in the treatment of lumbar disc herniation

目的本文探讨及评价直视下微创减压治疗腰椎间盘突出症的临床疗效及手术安全性。方法回顾性分析2008年1月至2010年12月期间进行直视下微创减压于术的56例腰椎间盘突出症的患者。男32例,女24例;年龄35～67岁,平均45岁。根据MRI影像学结果L_(3～4)节段12例,L_(4～5),节段29例,L_5～S_1节段22例,多节段15例。采用腰椎间盘突出的MSU分型分析,2-B型21例(37.5%),2-AB型20例(35.71%),2-C型8例(14.29%),其他类型:7例(12.5%)。术后随访10-16个月,平均12个月,分别在术前、术后2周、术后3个月、术后6个月和末次随访时,按照Oswestry功能障碍指数(oswestry disability index,ODI)和疼痛视觉类比评分(visual analogue scale,VAS)对患者的功能和疼痛程度进行评价,并依据改良MacNab标准评定对手术效果进行评价。结果 56例手术均顺利完成,手术时间35-60min,平均40±10min;术中山血量15～80ml,平均35±5ml,均未发生神经损伤等并发症,患者满意度高。术后不同评价时间点的功能和疼痛评分均较术前明显改善,差异有统计学意义(P<0.01)。术后不同时间点的功能和疼痛评分差异无统计学意义(P>0.05)。结论直视下微创减压治疗腰椎间盘突出症可显著改善患者的功能,维持腰椎的稳定性,临床疗效满意,是一种安全、有效、微创的手术方式。

Objective To investigate and evaluate the clinical effects and surgery safety of minimally invasive decompression under direct vision in the treatment of lumbar disc herniation. Methods A retrospective study was taken in 56 patients with lumbar disc herniation who were treated with the surgery of minimally invasive decompression under direct vision from January 2008 to December 2010. There were 32 males and 24 females with an average age of 45 years old （range; 35-67 years）. Based on the Magnetic Resonance Imaging （MRI） results, there were 12 patients with disc herniation at L34, 29 patients at L44, 22 patients at L5-S1 and 15 patients at multi segments. Based on the types of lumbar disc herniation analyzed by Michigan State University （MSU）, type 2-B was found in 21 patients （37.5%）, 2-AB in 20 patients （35.71%）, and 2-C in 8 patients （14.29%）. Others accounted for 7 patients （12.5%）. All the patients had gotten the postoperative mean follow-up of 12 months （range; 10-16 months）. According to the Oswestry Disability Index （ODI） and the Visual Analogue Scale （VAS）, the functional status and the pain degree were evaluated preoperatively, 2 weeks postoperatively, 3 months postoperatively, 6 months postoperatively and at the latest follow-up respectively. The surgery effects were measured by modified MacNab criteria as well. Results The surgeries were completed successfully in all the patients. The mean operating time was 40~10 minutes （range; 35-60 minutes） with the mean blood loss of 35~5ml （range; 15-80ml）. With a high level of patient satisfaction, there was no such complication as nerve injury and so on. The postoperative ODI and VAS scores at different time points improved significantly comparing with that preoperatively, and the differences were statistically significant （P〈0.01）. The differences among the postoperative ODI and VAS scores at different time points were not statistically significant （P〉0.05）. Conclusions The surgery of minimally invasive decompression under direct vision in the treatment of lumbar disc herniation can significantly improve the function of patients and maintain the stability of lumbar vertebrae. The clinical effects are satisfactory. It is a safe, effective, and minimally invasive surgery approach.