椎旁套管入路与后正中入路显微外科治疗腰椎间盘突出症的疗效比较

Comparison of microinvasive effect between paraspinal tubular retractor system and posterior median approach for treatment of lumbar intervertebral disc herniation

目的对比显微镜下椎旁套管入路与后正中入路治疗腰椎间盘突出症的疗效。方法49例腰椎间盘突出症患者随机分为椎旁套管入路组（n=28）和后正中入路组（n=21），对比两组手术前后指标。结果椎旁套管入路组在手术时间、出血量、卧床时间、住院时间以及局部伤口疼痛时间方面显著优于后正中入路组，术后1d、3d和5d的肌酸磷酸激酶均值明显低于后正中入路组，术后1周、6个月时JOA评分改善率显著高于后正中入路组（P〈0．05）；椎旁套管入路组术后1d．7dVAS评分低于后正中入路组（P〈0．05）。结论椎旁套管入路在出血量、肌肉创伤和临床症状缓解等方面优于后正中入路组。

Objective To compare the microinvasive effects between paraspinal approach and posterior median approach for the treatment of lumbar intervertebral disc herniation under microscope. Methods 49 cases of lumbar disc herniation were divided into one group of paraspinal approach with tubular retractor system （ n = 28 ） and the other group （ n = 21 ） with posterior median approach. We compared the associated parameters of two groups preoperatively and postoperatively. Results In operation time, intraoperative blood loss, bed time, length of admission and local wound pain, parspinal approach was superior to those of posterior median approach. The average value of the creatine phosphokinase （CPK） at the 1st, 3rd, and 5th days after the operation was lower than those of posterior median approach. The improvement rate of JOA score in 1 week and 6 months after operation in paraspinal approach was greater than those of posterior median approach （ P 〈 0. 05）. The VAS score of paraspinal approach at the 1 st and 7th days after operation was lower than those of posterior median approach （ P 〈 0.05）. Conclusions In terms of intraoperative blood loss, muscle trauma and clinical symptoms remission, the paraspinal approach using tubular retractor system is superior to the posterior median approach.