后路内窥镜下经单侧切口及双侧切口行双侧神经根减压治疗腰椎间盘突出症的对比研究

A comparing study of bilateral nerve root decompression through unilateral and bilateral incision for treatment of lumbar disc herniation

目的对经后路内窥镜下单侧切口及双侧切口行双侧神经根减压治疗腰椎间盘突出症疗效进行对比研究。方法将2010年10月～2012年10月收治的保守治疗无效伴双侧神经根受压的81例中央型腰椎间盘突出症患者随机分为实验组43例和对照组38例，实验组采取经单侧切口入路行双侧神经根减压及椎间盘切除术，对照组采取传统的双侧切口行双侧神经根减压及椎间盘切除术，对两种术式系列指标包括术中出血量、手术持续时间、切口长度、术后下床时间、术后住院天数、并发症及视觉模拟评分（VAS）、Macnab评分进行比较分析。结果①实验组较对照组切口小，术中出血量少，手术时间短，两组间差异有统计学意义（均P〈0．05）；而住院时间及术后下床时间差异无统计学意义（P〉0．05）。②两组术后1个月、末次随访，VAS评分与术前相比，均明显下降（P〈0．05）；两组间术前、术后1个月及末次随访VAS评分差异无统计学意义（均P〉0．05）。③实验组Macnab评分，术后1个月优良率93．0％，末次随访优良率95．3％；对照组术后1个月优良率97．4％，末次随访优良率97．4％，组间差异无统计学意义（P〉0．05）。结论经后路内窥镜下单侧切口行双侧神经根减压治疗腰椎间盘突出症是一种安全、有效、微创的治疗方案，具有临床应用价值。

Objective The efficacy of bilateral nerve root decompression through unilateral and bilateral incision for treatment of lumbar disc herniation was evaluated. Methods 81 central typelumbar disc herniationwith bilateral nerve root compression patients were randomly divided into the treatment and control groups. The control group was treated by bilateral nerve root decompressionthrough bilateral incision, and the treatment group was treated by bilateral nerve root decompression through unilateral incision. The efficacy and indexes were evaluated by comparative and statistical analysis. Results Our results showed that smaller incision, less bleeding, short operation time and the short time in bed were found in the experimental groups compared with that of the control groups. The hospitalization days and time in bed were no statistic differences between the two groups. One month after operation, VAS score of last follow-up decreased significantly in two groups compared with that after operation. There were no statistic differences in VAS score of last follow-up of the two groups between before and after operation. One month after operation, the excellent rate of Macnab score in the experimental group was 93.0%, and the excellent rate was 95.3% up to the last follow-up. The excellent rates in the control groups were 97.4 % and 97.4 % in post operation and last follow-up, respectively. Conclusions The bilateral nerve root decompression through unilateral and bilateral incision for treatment of lumbar disc herniation is safe, effective and minimally invasive.