内窥镜腰椎间盘切除术与开放式手术组织伤害的比较

Comparison of tissue damages caused by endoscopic lumbar discectomy and open lumbar discectomy

目的比较经皮内窥镜腰椎间盘切除术(PELD)和传统开放式手术(OD)对组织的伤害程度。方法前瞻性研究20例有症状腰椎间盘突出症患者,两组手术组随机收集10位患者,记录两组患者术中失血量、住院时间、切口大小。使用ELISA来测量IL-1β、IL-6、IL-8、IL-10、CRP、CPK在术前、术后1、6、12、24、48h的变化,术后使用VAS及改良MacNab标准来评估术后临床疗效。结果内窥镜组患者相对于传统手术的血流量小(P<0.01),更短的住院时间(P<0.01),更小的手术切口(P<0.01)。MacNab评估术后6个月两组均有90%满意度;术后3个月两组疼痛指数(P=0.661)无统计学意义;CRP、CPK、IL-6在术后24 h及48 h,开放手术组均高于内窥镜组(P<0.01),有统计学意义。结论内窥镜椎间盘切除手术相对传统开放手术具有相似的短期临床效果,具有切口小、出血少、组织损伤轻和恢复快的特点。

Objective The purpose of this study is to compare the overall effects of surgical trauma and surgical results resulting from PELD and OD. Methods The patients were randomly allocated into two groups, the PELD and OD groups. Each group contained 10 patients. Blood loss, hospital stay, and skin incision size will be recorded in these two groups. In this study, a quantitative comparison will be performed through analysis of patient's systemic cytokines, CPK and CRP response. An enzyme-linked immunosorbent assay(ELISA) was used for serum levels of Interleukin-1beta(IL-1), Interleukin-6(IL-6), and Interleukin-8(IL-8),Interleukin- 10(IL-10) and were measured before surgery and at 1,6,12,24 and 48 hours after surgery. Serum C-reactive protein(CRP) and creatine phosphokinase(CPK) were measured at the same time interval. Results The overall results showed PELD group had less blood loss( P<0.01), less hospital stay(P<0.01), less skin incision size(P<0.01) than OD group. Using the modified MacNab criteria, the clinical outcomes were 90% in PELD and OD group at the postoperative 6-month follow up. CRP、CPK、IL-6 level showed significant difference at 24 hours and 48 hours between the two groups(P<0.01). The systemic IL-6, CRP and CPK were significantly less following PELD than OD. Conclusion PELD offers a similar short-term clinical outcome,with smaller incision,less tissue trauma and quicker recovery than OD.