脊柱内镜下不同手术入路方法治疗腰椎间盘突出症的效果

Effect of different surgical approach spinal endoscopic treating lumbar disc herniation

目的研究脊柱内镜下椎旁肌间隙入路和传统后正中入路治疗腰椎间盘突出症的临床效果。方法选取湖北医药学院附属东风医院2013年8月~2015年6月收治的腰椎间盘突出症患者108例,采用随机数字法分为对照组和观察组,每组各54例。所有患者均在脊柱内镜下接受手术治疗,其中对照组患者采用传统后正中入路,观察组患者采用椎旁肌间隙入路,术后均获得随访1年,比较两组患者的手术效果及各种并发症发生率,同时比较术后不同时间腰背疼痛评分(VAS)和功能障碍指数(ODI)。结果观察组的手术时间、术中出血量、术后引流量及卧床休息时间均显著低于对照组(P<0.01),观察组术后1、7 d及1个月的VAS评分均显著低于对照组(P<0.01),观察组术后1、3个月及1年的ODI均显著低于对照组(P<0.01),两组患者并发症发生率比较,差异无统计学意义(P>0.05)。结论脊柱内镜下椎旁肌间隙入路手术治疗腰椎间盘突出症的效果显著,可明显减少手术时间及术中出血量,且术后并发症较少,同时可明显改善疼痛及功能障碍,具有较高的疗效和安全性,值得在临床推广。

Objective To study clinical efficacy of endoscopic spine and paraspinal intermuscular approach after tradi- tional posterior midline approach treating lumbar disc herniation. Methods From August 2013 to June 2015, in Dongfeng Hospital Affiliated to Hubei University of Medicine, 108 patients with lumbar disc herniation were selected and divided into the control group and the observation group by random number method. All the patients were treated with endoscopic spine surgery, the control group was treated with posterior midline approach, the observation group was treated with paraspinal intermuscular approach, all patients were followed up for 1 year after surgery, the complication rates and surgical effect index of two groups were compared, and the VAS score, disability index （ODI） at different time were also compared. Results The operation time, blood loss, postoperative drainage and bed rest time in the observation group were significantly lower than those in the control group （P 〈 0.01）, the VAS scores after operation 1, 7 d and 1 month in the observation group were significantly lower than those in the control group （P 〈 0.01）, and the ODI after operation 1, 3 months and 1 year in the observation group were significantly lower than the control group （P 〈 0.01）, and there was no significant difference of the incidence between the two groups （P 〉 0.05）. Conclusion Endoscopic spine paraspinal intermuscular approach surgical treatment the lumbar disc herniation has a significant efficacy, it can significantly re- duce operative time and blood loss, it has a fewer postoperative complications, and it can significantly improve pain and dysfunction, so it has high efficacy and safety that worthy of promotion.