显微内窥镜治疗青中年外伤性腰椎间盘突出症的临床疗效观察

The clinical efficacy of microendoscopy discectomy in the treatment of traumatic lumbar disc herniation

目的评估显微内窥镜腰椎间盘切除系统(microendoscopy discectomy,MED)治疗外伤性腰椎间盘突出症的临床效果及应用价值。方法收集并分析2010-01~2014-09在该院行MED治疗的67例外伤性腰椎间盘突出症患者的临床资料,其中男39例,女28例,统计患者的手术时间、术中出血量、术后第1天引流量及住院时间,采用疼痛视觉模拟评分(VAS评分)及改良Macnab评分标准评判手术前后患者疼痛改善情况及腰部功能恢复情况。结果该组患者术后随访1年以上,手术时间为(53.88±12.33)min,术中出血量为(37.53±12.69)ml,术后第1天引流量为(16.49±8.96)ml,术后住院时间为(5.97±1.54)d。术后1、3、6、12个月VAS评分均有明显降低,与术前相比差异有统计学意义(P<0.05)。末次随访时按改良Macnab疗效评定标准,优52例(77.61%),良10例(14.92%),可4例(5.97%),差1例(1.49%),优良率为92.54%。结论MED应用于外伤性腰椎间盘突出症的治疗有着其独到的优势。

Objective To evaluate the effect and clinical value of microendoscopy discectomy（MED） on the treatment of traumatic lumbar intervertebral disc herniation. Methods The clinical data of 67 patients with traumatic lumbar disc herniation who were performed MED from January 2010 to September 2014 were collected and retrospectively analysed,including 39 males and 28 females. The operation time,blood loss,total volume of drainage after the first postoperative day and the postoperative length of stay were surveyed in all cases. VAS score and modified Macnab scoring criteria were used to evaluate the functional pain relief and restoration of spine. Results The mean operation time was（53. 88 ± 12. 33） min. The mean blood loss was（37. 53 ± 12. 69） ml. The total volume of drainage after the first postoperative day was（16. 49 ± 8. 96） ml. The average postoperative length of stay was（5. 97 ± 1. 54） d.Compared with those before the operation,Visual analogue scale（VAS） decreased significantly 1,3,6 and 12 months after the operation（P〈0. 05）. According to the modified Macnab scoring criteria,the clinical outcome was excellent in 52 cases（77. 61%）,good in 10 cases（14. 92%）,acceptable in 4 cases（5. 97%）,and 1 case（1. 49%） got a worse outcome. The successful rate was 92. 54%. Conclusion MED has a unique advantage in the treatment of traumatic lumbar intervertebral disc herniation.