后路内窥镜下髓核摘除联合纤维环缝合技术治疗腰椎间盘突出症的临床观察

Clinical observation of MED combined with fibrous ring suture technique in the treatment of lumbar disc herniation

目的探讨内窥镜下椎间盘髓核摘除术(Microendoscopic discectomy,MED)治疗腰椎间盘突出症(Lumbar disc herniation,LDH)手术中,予以纤维环缝合技术处理的临床价值。方法共纳入2013-04-2015-04,行MED手术治疗的97例LDH患者,其中42例术中对纤维环切口或破裂口予以缝合处理,作为研究组;另55例仅予以单纯的MED手术,作为对照组。对两组患者术后随访2年以上,统计并对比相关手术指标。结果两组随访平均27.1个月。研究组的手术时间和术中出血量稍高于对照组,但无统计学差异(P>0.05)。与术前相比,两组术后3个月和末次随访时的腰腿疼痛VAS评分和ODI指数均显著改善,且椎间隙高度均有丢失现象(P<0.05),但组间对比无统计学差异(P>0.05)。研究组术后复发率及再手术率均仅2.38%,对照组高达10.91%及9.09%,显著高于研究组(P<0.05)。结论在MED手术治疗LDH过程中,予以纤维环缝合技术进行处理可有效降低术后复发率和再手术率,具有一定的临床应用价值。

Objective To explore the Microendoscopic discectomy(MED) in the treatment of lumbar disc herniation (LDH) in the operation, to the clinical value of fiber ring suture technique. Methods 97 cases of patients with LDH -2015 in April 2013 April for the surgical treatment of MED were included, among them, 42 cases were sutured with fibrous ring incision or broken mouth, as the study group;the other 55 cases only received only MED surgery as the control group. The patients in the two groups were followed up for more than 2 years, and the relative operative indexes were compared and analyzed. Results Two groups of patients were successfully completed the operation, followed up for 25-31 months, with an average of 27.1 months. The time of operation and the amount of bleeding in the study group were slightly higher than those in the control group, but there was no statistical difference (P> 0.05). Compared with the preoperative, two groups after 3 months and the final follow-up of the lumbar and leg pain VAS score and ODI index were significantly improved, and the height of intervertebral space by loss (P<0.05), but no significant difference between the groups (P>0.05). The recurrence rate and reoperation rate of the study group were only 2.38%,the control group was up to 10.91% and 9.09%, significantly higher than the study group (P<0.05). Conclusion It is effective to reduce the recurrence rate and reoperation rate in the MED operation for LDH, and it has a certain clinical value.