经皮椎间盘镜与传统开窗髓核摘除术治疗腰椎间盘突出症疗效比较

Comparison of the clinical efficacy of microendoscopic discectomy and traditional open discectomy for lumbar intervertebral disc protrusion

目的比较椎间盘镜下髓核摘除术(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。方法对125例腰椎间盘突出症患者根据其临床表现、影像学检查及患者的选择确定手术方式,MED组65例,传统手术组60例。对两组的切口长度、手术时间、术中出血量、术后卧床时间进行比较分析。按JOA腰痛评分标准评估疗效。结果两组的切口长度、术中出血量、手术时间、术后卧床时间两组比较差异有统计学意义(P<0.05)。两组均顺利完成手术。术后两组JOA评分均较术前明显改善,差异有统计学意义(P<0.05);两组间各时段JOA评分优良率比较差异无统计学意义(P>0.05)。MED组出现3例脑脊液漏、传统手术组2例脑脊液漏。MED组出现3例腰椎间盘突出复发,传统手术组1例复发。两组并发症比较差异无统计学意义(P>0.05)。结论 MED与传统手术治疗腰椎间盘突出症均可以获得较好的临床疗效。

Objective To compare the clinical effect of microendoscopic discectomy（ MED） and open discectomy（OD） for lumbar intervertebral disc protrusion（LIDP）. Methods 125 patients with lumbar disc herniation were included in the study,the surgical approach was determined in these patients with LIDP according to clinical manifestations,imaging examination and the patient＇ s choice. 65 patients were underwent MED and 60 patients were underwent OD. The operation time,intraoperative bleeding volume,postoperative bed rest time and postoperative hospitalization time were compared between two groups. The clinical efficacy was assessed according to the lower back pain scoring standard of JOA. Results There was statistical difference between two groups in the length of incision,intraoperative bleeding volume and the operation time,postoperative bed rest time（ P〈0. 05）. Both groups were successfully operated. The postoperative JOA score of two groups were obviously improved comparing with the preoperative JOA score（ P〈0. 05）. The difference of JOA score＇ s excellent rate was not statistically significant between two groups in each postoperative time（ P〈0. 05）. MED group had three cases of cerebrospinal fluid leakage,and OD group had 2 cases. MED group had three cases of recurrent lumbar disc herniation,and OD group had one case.There was no statistically significant difference between the complication rates of two groups. Conclusions MED and OD treatment for LIDP can obtain good effect.