椎间盘镜与椎板开窗治疗腰椎间盘突出症的临床比较

Comparison between Microendoscopic Discectomy and Traditional Laminectomy for Lumbar Disc Herniation

目的:比较微创椎间盘镜(MED)和传统椎板开窗髓核摘除术治疗腰椎间盘突出症的临床疗效、优缺点及适应证。方法:从2005年1月-2010年12月共440例单节段腰椎间盘突出症患者中,根据患者临床表现、影像学检查及患者的选择确定手术方式,其中94例施行单节段微创MED,346例施行单节段传统椎板开窗手术。分别对2组的手术时间、术中出血量、并发症、术后恢复时间进行比较分析;术后随访按Macnab疗效标准统计术后优良率。结果:微创MED手术组优良率为95.3%,传统椎板开窗组优良率为92.5%,差异无统计学意义(P>0.05),2组手术时间、并发症比较差异无统计学意义;出血量、术后恢复时间比较差异有统计学意义。结论:2种手术方式疗效相近,均是治疗腰椎间盘突出症的有效方式,其中微创椎间盘镜具有手术创伤小、恢复快的优点,但其对手术技术要求较高,尤其适合于单纯腰椎间盘突出症患者;而传统椎板开窗创伤相对较大,术后恢复较慢,但其对手术技术要求较低,适应证宽,更适合合并复杂椎管情况的腰椎间盘突出症患者。

Objective：To compare the clinical efficacy, advantages and disadvantages, and indications of microendoscopic discectomy （MED） and traditional laminectomy in treating lumbar disc herniation. Methods： From January 2005 to December 2010, 440 patients with single lumbar disc herniation were included in the study. According to the clinical manifestations, imaging examination and the choice of patients, 94 patients underwent single-segment minimally invasive MED, and the rest 346 patients received traditional single-segment laminectomy and fenestration. The operative time, blood loss, complications, and postoperative recovery time were compared between the two groups. The effective rate was calculated by Macnab standard during the postoperative follow-up. Results：The effective rate was 95.3% in MED group and 92.5% in laminectomy group, showing insignificant difference between the two groups （P〉0.05）. No significant difference was found in operative time and complications between the two groups （P〉0. 05）, but as for blood loss and postoperative recovery time, the difference was statistically significant （P〈0.05）. Conclusion：MED and traditional laminectorny have similar clinical efficacy, both of which are effective surgical methods for lumbar disc herniation. MED has the advantages of minimal invasion and quick recovery, but needs more sophisticated techniques; traditional laminectomy has relatively large invasions and longer postoperative time, but the surgery is relatively easy with broader implications, suitable for patients with more complicated conditions.