显微内镜与传统开窗髓核切除术骨质切除范围及对腰椎退变影响的比较  

Comparison of Spinal Bone Removal Scale with MED and IFAD and Their Postoperative Effects on Lumbar Degeneration

作　　者：张洪斌[1] 李永民[1] 王旭[1] 曹恒聪[1] 原野[1] 谷守山[1] 

机构地区：[1]河北省唐山市第二医院脊柱外科,唐山063000

出　　处：《中国微创外科杂志》2008年第9期819-821,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的比较显微内镜椎间盘切除术(microendoscopic discectomy,MED)与传统开窗髓核切除术骨质切除范围及对腰椎退变的影响。方法MED组76例,传统开窗组80例。比较2种手术方法髓核切除量,手术前后X线正位片,测量手术所开骨窗的窗宽、窗高,手术中上、下关节突切除范围,按Nakai标准评价疗效,观察术前、术后随访时椎间隙高度变化及椎体矢状位位移和角度改变。结果MED组无论是骨窗的窗宽、窗高,还是上、下关节突切除百分比都明显小于传统开窗组(P=0.000),而髓核摘除量则没有明显差异[分别为(1.75±0.58)和(1.95±0.77)g,t=-1.825,P=0.070]。MED组与传统开窗组优良率分别为86.8%和88.8%,差异无显著性(Z=-0.184,P=0.854)。术后椎间隙高度变窄百分比和椎间不稳发生例数2组差异无显著性(分别为0.30±0.18和0.34±0.15,t=-1.246,P=0.215;3例和5例,x^2=0.425,P= 0.515)。结论2种手术方法均疗效良好,椎间盘镜手术创伤小,对腰椎骨性结构破坏少,应作为手术治疗椎间盘突出症的首选。Objective To compare the scale of the spinal bones removed by microendoscopic discectomy （MED） and interlaminal fenestration approach discectomy （IFAD） , and their postoperative influence on the lumber degeneration in patients with lumber disc herniation. Methods Totally 76 cases of MED and 80 cases of IFAD were enrolled in this study, The scale of the spinal bones resected were compared by measuring the width and height of the bone window, as well as the percentages of the removed superior and inferior articular processes by using X-ray, To compare the efficacy of the two procedures, Nakai criteria was employed. The height and angle of intervertebral space and intervertebral displacement were detected preoperation, and then were followed up after the surgery. Results Both the width and height of the bone window and the percentages of the removed superior and inferior articular processes of the MED group was significantly less than those in the IFAD group （P = 0. 000） ; whereas, no marked difference was found in the scale of disc removal between the two group [ （1.75±0.58） g vs （1.95 ±0.77） g, t = - 1. 825, P =0. 070]. The outcomes of the two group was similar, the rate of excellent and good outcomes of the MED and IFAD groups were 86.8% and 88.8% , respectively （Z = -0. 184, P = 0. 854）. In the MED group, the intervertebral space was reduced by 30%±18% , which were similar to that in the IFAD group 34%±15% （t = - 1. 246, P =0. 215）; 3 cases of the MED group and 5 of the IFAD group had intervertebral instability after the surgery （X^2 = 0. 425, P = 0. 515）. Conclusions Both MED and IFAD are effective for lumbar disc herniation. However, MED shoud be the first choice for the disease, because the procedure causes less trauma.

关 键 词：显微内镜椎间盘切除术 腰椎间盘突出症 腰椎不稳定 

分 类 号：R687.3[医药卫生—骨科学]