后路椎间盘镜以及开放髓核摘除术应用于腰椎间盘突出者的治疗效果比较

Compare The Effect of Nucleus Pulposus Excision Surgery of Using Posterior Intervertebral Disc Mirror and Open Technique For Lumbar Disc Prominent Patient

目的比较后路椎间盘镜(Microendoscopic discectomy,MED)以及传统开放手术(Open discectomy,OD)治疗腰椎间盘突出症(Lumbar disc herniation,LDH)的效果。方法选取2012年6月至2013年12月收治的62例腰椎间盘突出症患者,行后路椎间盘镜下髓核摘除术患者29例为MED组,行传统开放髓核摘除术33例为OD组,比较两组手术时间、切口、出血和住院时间,围手术期切口疼痛JOA以及术前、术后3月的Oswestry功能障碍指数。结果 MED组相比OD组手术时间明显缩短、切口长度减小、术中出血量减少、术后住院时间缩短(P<0.05)。两组患者术前的JOA评分无统计学差异,术后1周以及1月的疼痛评分观察组明显改善,观察组更加明显(P<0.05)。术后3月疼痛评分比较无统计学差异P<0.05)。本研究中62例患者均痊愈出院,两组患者术前的ODI评分无统计学差异(P>0.05),术后经过3个月的随访提示两组手术对患者的近期疗效评估无统计学差异。结论后路椎间盘镜下髓核摘除术相比于传统开放手术时间短、切口小、出血量少以及术后恢复快,疼痛轻、微创等特点,是一种很好的治疗方式。

Objective To compare the effect of nucleus pulposus excision surgery of using posterior intervertebral disc mirror and open technique for lumbar disc prominent patient. Methods Select 62 cases of patients with single segmental lumbar interverte-bral disc protrusion from June 2012 to December 2013 in our hospital, 29 of whom underwent posterior intervertebral disc microscopi-cally, for MED group, another 32 patients received routine traditional open surgery,for OD group, compared operation time, incision length, intraoperative hemorrhage, length of hospital stay,perioperative pain JOA and preoperative and postoperative incision Oswestry disability index in two groups. Results The MED group compared with OD group operation time was significantly shortened, intraop-erative blood loss, postoperative incision length and hospitalization time was all significantly better （all P〈0. 05）. No obvious differ-ence was found between two groups of patients with preoperative JOA score, postoperative 1 week and 1 month pain score was both sig-nificantly improved, but the MED group was more obviously （P〈0. 05）. Postoperative pain score after 3 months had no significant difference （P〈0. 05）;In this study, 62 patients were all recovered, no obvious difference was found between two groups of patients with preoperative ODI score （P〉0. 05）, after follow-up for 3 months of there was no difference of the recent curative effect evalua-tion. Conclusion Posterior intervertebral disc microscopically using in excision of nucleus pulposus compared to traditional open sur-gery the operating time is short, have small incision, less blood loss and postoperative recovery is fast,have the characteristics of mini-mally invasive, is worthy of popularization and application.