椎间盘镜治疗腰椎间盘突出症的中期疗效观察

Midterm outcomes of microendoscopic discectomy in the treatment of lumbar disc herniation

目的观察椎间盘镜（microendoscopic discectomy,MED）下髓核摘除术治疗腰椎间盘突出症的中期临床疗效。方法回顾性分析2010年12月至2013年12月,我院收治的73例腰椎间盘突出症患者,共74个椎间隙,均行MED下髓核摘除术,其中男46例,女27例,年龄22-75岁,平均年龄45.8岁,采用疼痛视觉模拟评分（visual analogue scale,VAS）和Mac Nab标准评价术后疗效。结果所有患者均获得随访,随访时间为36-60个月,平均49.8个月,所有患者术前腰腿痛VAS评分（6.93±0.86）分,术后3个月（1.56±0.83）分,术后1年（1.36±0.74）分,末次随访（1.26±0.74）分,术后各时间点腰腿痛VAS评分较术前有明显改善,差异有统计学意义（P〈0.01）。中期随访疗效：Mac Nab标准,优55例、良11例、可4例、差3例,优良率90.4%。术后复发3例,1例保守治疗,2例再次手术,复发率为4.1%。1例术前有足下垂、术后恢复不满意。结论 MED下髓核摘除术具有手术创伤小、术后恢复快、并发症少的特点,是椎间盘突出症治疗的有效方法,中期疗效满意。

Objective To evaluate midterm outcomes of microendoscopic discectomy （ MED ） in the treatment of lumbar disc herniation. Methods From December 2010 to December 2013, 73 patients （ 74 discs, 46 males and 27 females ） with lumbar disc herniation received MED. The average age was 45.8 years （ range： 22 - 75 years ）. Clinical outcomes were evaluated by the visual analogue score （ VAS ） and MacNab standard. Results All patients completed the follow-up. The mean follow-up was 49.8 months （ range： 36 - 60 months ）. VAS scores preoperatively, 3 months postoperatively, 1 year postoperatively and the latest follow-up were （ 6.93 ± 0.86 ） points, （ 1.56 ± 0.83 ） points, （ 1.36 ± 0.74 ） points, and （ 1.26 ± 0.74 ） points. Postoperative VAS scores were significantly lower than those before the surgery （ P 〈 0.01 ）. Medium-term follow-up efficacy： MacNab standard, excellent in 55 cases, good in 11 cases, fair in 4 cases, poor in 3 cases, the excellent and good rate was 90.4%. Postoperative recurrence occurred in 3 cases： 1 case received conservative treatment and 2 cases underwent the second stage operation, the recurrence rate was 4.1%. One case with foot drop was not satisfied with the result. Conclusions MED is an effective procedure with good mid-term outcomes in the treatment of lumbar disc herniation. The advantages of the procedure include less tissue trauma, less postoperative complications and early postoperative recovery.