显微内镜椎间盘切除术与传统术式对肌肉损伤影响的比较研究

Comparison of the Muscle Injury Caused by Microendoscopic Discectomy and Conventional Surgery

目的通过比较显微内镜椎间盘切除术(MED)与传统椎间盘切除术治疗后,患者的肌酸磷酸激酶(CPK)、多裂肌横断面面积(CSA)以及视觉模拟评分量表(VAS)的变化,探讨MED与传统术式对肌肉损伤的影响。方法选择我院收治的腰椎间盘突出致坐骨神经痛患者200例,随机分为MED组与传统组各100例,采用VAS测量腰背痛的严重程度,CPK量化肌肉损伤,CSA量化多裂肌萎缩程度。结果 MED组术后CPK为(167.1±45.8)U/L、传统组为(268.1±82.4)U/L,两组比较差异有统计学意义(t=42.216,P<0.01)。MED组术后1年CSA为(805±185)mm2、传统组为(743±141)mm2,两组比较差异有统计学意义(t=10.574,P<0.01)。MED组术后1年腰背痛VAS均值为(17.32±4.14)mm,传统组为(22.23±5.76)mm,两组比较差异有统计学意义(t=11.587,P<0.05)。结论 MED相对于传统术式,具有创伤小,疗效好,恢复速度快的优点,其对肌肉造成的损伤小于传统术式。

Objective To compare the changes of creatine phosphokinase（CPK）,cross-sectional area（CSA）of the multifidus muscle and visual analogue rating scale（VAS）treated by microscopic endoscope discectomy（MED）and conventional discectomy method in order to explore the impact on muscle injury by the two methods.Methods 200 patients with lumbar disc herniation caused sciatica in Hubei Medical School Affiliated Taihe Hospital were selected and randomly divided into the MED group and traditional group with 100 cases in each group.VAS was used to measure the severity of low-back pain.CPK was used to quantify muscle damage.CSA was used to quantify the multifidus muscle atrophy.Results The postoperative CPK in the MED group was（167.1±45.8）U/L,and that in the traditional group was（268.1±82.4）U/L.The postoperative CPK in the MED group was significantly lower than that in the traditional group.The difference of the two groups was statistically significant（t=42.216,P0.01）.The postoperative one-year CSA in the MED group was（805±185）mm2,and that in the traditional group was（743±141）mm2.The difference of the two groups was statistically significant（t=10.574,P0.01）.The one-year VAS of low-back pain in the MED group was（17.32±4.14）mm,and that in the traditional group was（22.23±5.76）mm.The difference of the two groups was statistically significant（t=11.587,P0.05）.Conclusion Compared with the traditional operation,MED has the advantages of smaller trauma,better efficacy,faster recovery and less muscle injury.