不同手术方式对腰椎间盘突出症治疗的效果比较分析

The Comparative Analysis of Therapeutic Effects on Different Surgical Treatment of Lumbar Disc Herniation

目的:探讨应用微创技术治疗腰椎间盘突出症的疗效。方法:对我院脊柱骨科自2005年11月～2010年10月收治的128例腰椎间盘突出症患者应用不同手术方式进行治疗,其中应用APLD(automated percutaneous lumbar discectomy)治疗单纯腰椎间盘突出症48例;应用MED(microendoscopic discectomy)治疗复杂型腰椎间盘突出症42例;应用传统后路椎板开窗技术治疗单纯腰椎间盘突出症38例;比较各组手术时间、术中出血、术后住院时间、疗效及并发症。术后均随访8个月～3年,观察复发情况。结果:三组不同手术方式手术时间及优良率比较差异无统计学意义(P>0.05),APLD及MED组术中出血量及术后住院时间与传统手术组比较,差异有显著性(P<0.05);术后随访疼痛全部缓解,无复发。结论:在严格掌握适应症的基础上,采用微创技术和采用传统手术治疗腰椎间盘突出症疗效相当,但微创技术创伤小、术中出血量少,术后住院日短,恢复快,优于传统手术。

Objective： To investigate the therapeutic effects of lumbar disc herniation by minimally invasive techniques. Methods： Different surgical treatments were adopted for 128 patients with lumbar disc herniation in our hospital during November 2005 and October 2010. APLD （automated percutaneous lumbar discectomy） were applied to 48 cases of simple lumbar disc herniation, and MED （mi- croendoscopic discectomy） were applied to 42 cases of complex lumbar disc herniation, and traditional posterior laminectomy window technology were applied to another 38 cases of simple lumbar disc herniation. Compare the operation time, the blood loss during opera- tion, postoperative hospital time, therapeutic effects and complications after operation among different groups and observe the recurrence after operation by follow-up. Results： There is no significant difference in operation time and excellence rate of therapy among different surgical treatment （P〉 0.05）. The blood loss during operation and postoperative hospital time of APLD group and MED group were sig- nificantly lower than conventional surgery group （P〈0.05）. All pain relieved and no recurrence was found in follow-up. Conclusion： On the basis of strictly controlling indications, the therapeutic effects of lumbar disc herniation with minimally invasive techniques are equiv- alent to the one with conventional surgery, but patients with minimally invasive techniques possess smaller trauma, less blood loss during operation, and shorter postoperative time.