两种微创手术方式治疗巨大型腰椎间盘突出症临床疗效的比较

Comparison of Two Kinds of Minimally Invasive Surgical Treatment of Giant Lumbar Disc Herniation

目的探讨显微镜下椎间盘摘除术(MSLD)和Quadrant辅助通道下治疗单节段巨大型腰椎间盘突出症中短期的临床疗效比较。方法方便选取2013年8月—2016年10月该院收治28例单节段巨大型腰椎间盘突出症患者,其中,15例行经后路显微镜辅助下髓核摘除术,13例行经后路Quadrant辅助通道下髓核摘除术。比较两组患者手术时间、术中出血量以及术前、术后随访视觉模拟评定(VAS)评分、功能障碍指数(ODI)评分、改良Macnab评估标准评估临床疗效。结果 MSLD组与Quadrant组手术时间分别为(60.33±2.20)min和(74.85±1.62)min,术中出血量分别为(30.13±0.91)m L和(35.23±1.02)m L。MSLD组术前VAS评分(6.73±0.27)分,术后3个月(1.47±0.24)分,末次(1.07±0.15)分;术前ODI评分(44.00±0.45)分,术后3个月(13.67±0.51)分,末次(13.93±0.63)分。Quadrant组术前VAS评分(6.77±0.30)分,术后3个月(1.69±0.26)分,末次(1.31±0.24)分;术前ODI评分(44.38±0.47)分,术后3个月(16.00±0.42)分,末次(16.54±0.66)分。术后随访6个月~2.5年(平均1.6年),两组VAS评分、ODI评分术后3个月与末次随访较术前均有显著改善(P<0.001),组间比较亦差异有统计学意义(P<0.05)。手术时间、术中出血量MSLD组均少于Quadrant组(P<0.001)。术后切口均Ⅰ期愈合。无手术间隙定位错误、神经根和马尾神经损伤及感染等并发症发生。结论 MSLD和Quadrant两种微创手术方式均可对单节段巨大型腰椎间盘突出症取得良好的临床效果,两者均具有创伤小、安全、并发症少、效果好等优点,但MSLD在手术时间、出血量等方面更具有优势。是治疗单节段巨大型腰椎间盘突出症的一种较为理想的手术方式。

after 3 months was(1.69±0.26)points and the last was(1.31±0.24)points respectively.The ODI score before the operation was(44.38±0.47)points,three months after operation was(16.00±0.42)points,the last was(16.54±0.66)points.In the followup period of 6 months to two and half year(average of 1.6 years),the VAS score,ODI score of 3 months after operation and the last follow-up were significantly im proved(P<0.001),and there was significant difference between the two groups(P<0.05).The time of operation and the am ount of intraoperative blood loss were less than that of Q uadrant group(P<0.001).All the incisions were healed in the stage I.No surgical gap positioning errors,nerve root and cauda equina injury and infection and other com plications happened.Conclusion Both MSLD and Q uadrant m inim ally invasive methods can achieve good clinical effect on single lum bar disc herniation.Both of them have the advantages of small traum a,safety,less com plication and good effect,but MSLD is more effective in the surgical tim e,bleeding am ount and other aspects,which is an ideal treatm ent m ethod of a single segm ent of the huge lum bar disc herniation.Objective This paper tries to investigate the short-term clinical efficacy of m icrodiscectom y surgery of lum bar disc(MSLD)and Q uadrant auxiliaries in the treatm ent of giant lum bar disc herniation with single segm entation.Methods 28 patients with m assive lum bar disc herniation from August 2013 to October 2016 were convenient enrolled in this study.Among them,15 cases underw ent posterior m icrom anectom y and 13 cases were treated by posterior quadrant auxiliary channel Lower nucleus pulposus removal.The operative tim e,intraoperative blood loss,preoperative and postoperative follow-up visual analogue(VAS)score,dysfunction score(ODI)score,improved M acnab evaluation criteria were used to evaluate the clinical efficacy.Results The operative tim e was(60.33±2.20)m in and(74.85±1.62)m in for MSLD and Q uadrant group,The blood loss was(30.13±0.91)m L and(35.23±1.02)m L.VAS score of the MSLD group were(6.73±0.27)points before the operation,(1.47±0.24)points of 3 months after operation,(1.07±0.15)points of the last follow-up after the operation respectively;The ODI score before the operation was(44.00±0.45)points,three months after operation was(13.67±0.51)points,the last was(13.93±0.63)points.while in the Q uadrant group,the VAS score was(6.77±0.30)points,the postoperative score