应用关节镜行微创腰椎间盘摘除手术

Micro Lumbar Discectomy under Arthroscopy

目的 比较小切口腰椎间盘摘除手术与常规手术。方法 34例小切口(1.5～2 cm)的关节镜下腰椎间盘摘除手术病例与同期常规腰椎间盘摘除手术73例病例比较。采用oswestry disability guestionnaire(ODQ)对手术前后的病人进行评分;比较手术前后ODQ的百分比,手术中的出血量,手术的时间,手术并发症。结果微创腰椎间盘摘除手术与常规手术相比,手术前后ODQ的改变两组都有显著性差异,但微创与常规相比无论是术前还是术后都无显著性差异。微创术中有3例在术中扩大切口改行常规手术,2例为发生椎管前静脉出血,1例出现硬膜破裂,分别在扩大切口后行止血和修补硬膜。手术时间、手术并发症的发生率两组相比没有显著性差异。微创组手术中的出血量显著减小,平均为72.94 mL(P<0.001)。结论 小切口腰椎间盘摘除手术是一种损伤小、出血少、病人术后恢复快的手术方式,可适用于椎间盘突出椎板开窗髓核摘除术和神经根管狭窄扩大术。有可能因为出血和硬膜破裂而扩大切口改为常规手术。

Purpose: To compare micro discectomy with usual discectomy. Methods: Thirty-four cases of discectomy under arthroscopy were compared with 73 cases of usual discectomy. We recorded the oswestry disability questionnaire (ODQ) of all patients pre- and post-operation. Between these two groups, we compared the ODQ, the bleeding during operation, the time of operation and the complication. Results: The ODQ was significantly different pre- from post- operation in both groups. But no significant difference was found between two groups. In 3 cases of micro discectomy the insections were enlarged, in two cases to stop the bleeding of vein outside dura, in one case to repair the dura. There was no significant difference in operation time and complication between two groups. But the bleeding was significant less in micro discectomy than the usual(P < 0.001). Conclusions: Micro lumbar discectomy under arthroscopy is a kind of safe, less bleeding and recove-ry soon surgery. We can do the discectomy and decompression of the nerve loot. It would be enlarged the insection because of the bleeding and dura broken.