腰椎间盘突出症的辅助MED手术治疗

THE ASSISTANT MED OPERATION FOR LUMBAR DISC HERNIATION

目的 :探讨辅助MED手术作为腰椎间盘突出症 (Lumbardischerniation ,LDH)的一种新术式的临床价值。方法 :通过CT计量诊断将LDH分为Ⅰ～Ⅳ型 ;对 2 5例Ⅲ、Ⅳ型LDH患者 (A组 ) ,通过开放式小切口椎板开窗术式进入椎管后 ,采用后路脊柱显微内窥镜处理椎管内病变 (辅助MED手术 ) ,与传统开放式手术治疗的82例Ⅲ、Ⅳ型LDH患者 (B组 )做疗效比较。结果 :A、B两组的皮肤切口平均长度分别为 4 .2cm与 8.3cm ,术中平均出血量分别为 1 50ml与 2 85ml,术后平均下地时间分别为 9.5d与 2 1d ,差异有极显著性意义 (P <0 .0 1 ) ;A组全部获得随访 ,平均随访 1 4个月 ,B组 67例获得随访 ,随访率 81 % ,平均随访 2 .5年 ,按Macnab标准评定疗效 ,A组优 68.0 %、良 2 4 .0 %、可 8.0 % ,B组优 41 .8%、良 47.8%、可 7.4%、差 3 .0 % ,差异有显著性意义 (P <0 .0 5)。结论 :辅助MED手术比传统开放式手术损伤小、康复快、疗效达优率高 ,对突出椎间盘已破裂游离和 /或合并中央椎管狭窄的LDH患者 ,不失为一种具有一定推广价值的“微创”

Objective:To explore the clinic value of the assistant MED operation as a new treatment to lumbar disc herniation. Methods:Divided lumbar disc herniation into 4 types by CT quantitive diagnosis and performed the assistant MED operation on 25 cases with type Ⅲ or type Ⅳ lumbar disc herniation(group A) .Compared the effect with that of 82 cases with type Ⅲ or type Ⅳ lumbar disc herniation(group B) were treated by conventional operation. Results:The average length of incision was 4.2cm and 8.3cm respectively in group A and group B. The average volume of blood lost in operation was 150ml and 285ml The average time from operation to walk was 9.5 days and 21 days. The difference was very markedly ( P <0.01) .Group A had gotten follow-up for 14 months average. Sixty-seven cases in group B(81%) had gotten follow-up for 2.5 years average. Evaluated the effect according to the Macnab standard, excellent was 68%, fine was 24%, acceptable was 8.0% in group A and excellent was 41.8%, fine was 47.8%,acceptable was 7.4%, poor was 3.0% in group B. The difference was markedly ( P <0.05).Conclusion:The assistant MED operation make less injuries and get better effect than the conventional operation. It is a certain extent worthy of being popularized to treat the patient with lumbar disc herniation which the disc had broken and dissociated and/or with the complication of center vertebral canal constriction.