腰椎间盘突出症传统手术方式与内窥镜(MED)疗效的回顾性分析  

Retrospective analysis of clinical effects between traditional open discectomy and microendoscopy(MED) for lumbar disc herniation

作　　者：戴守达[1] 董小雄[1] 张耘[1] 王永宏[1] 张洪思[1] 周正顺[1] 陈刚[1] 吕峰[1] 刘洪业[1] 韩顺[1] 

机构地区：[1]解放军第86医院骨科,安徽当涂243100

出　　处：《颈腰痛杂志》2010年第5期349-351,共3页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨传统开放的椎板间隙"开窗"手术方式(A组)和MED(B组)治疗腰椎间盘突出症的临床效果及相关问题。方法根据临床表现结合影像学检查结果确定手术方式,625例施行开放手术,其中单间隙开窗482例、单侧双间隙开窗65例、双侧开窗78例;546例施行MED。根据Nakai标准评价疗效,并对手术时间、出血量、并发症、术后恢复时间进行比较分析。结果开放手术组优良率为94.2%,MED手术组优良率为98.3%,差别无统计学意义(P>0.05),两组手术时间、并发症无显著性差异,出血量、术后恢复时间有统计学意义。结论两种手术方式疗效相近,传统开放手术仍然是治疗腰椎间盘突出症的主要手段,MED作为现代微创技术,具有手术创伤小、恢复快的优点,但手术并不简便,且技术要求更高,只要具备熟练的开放手术技术,在严格选择适应证的前提下才能获得优良效果。Objective To evaluate clinical effects and relating problems of traditional opening lumbar discectomy（group A）and contemporary microendoscopy（MED）（group B）treated lumbar disc herniation.Methods According to clinical manifestation and image results,625 cases of lumbar disc herniation were operated upon with traditional open discectomy,546 cases with MED.Naikai＇s criteria was used to assess the clinical outcomes,with comparatively analyzing operating time、the volume of blood lose、complications and postoperative recovery time.Results The rate of exellent and good in group A was 94.2%,and group B was 98.3%.There was no significant differences between two groups（P0.05）.The mean operating time in group A was 75.6 minutes,and 67.7 minutes in group B,which had no statistical significance（P0.05）.There were 8 cases complication in group A,3 cases complication in group B,which had no statistical significance（P0.05）.There was significance differences in the volumes of blood lose、postopereting recovery time between two groups（P0.05）.Conclusion The clinical outcome of two groups are same satisfactory.The laminectomy discectomy is always main method to treat lumbar disc herniation.being a minimally invasive procedure in spinal surgery,MED has advantage of minimal incision、less blood lose、speed recovery and less damage to posterior column of lumbar spine,but it can＇t fully replace the convetional discectomy.However,under the condition of masterring the convetional discectomy skill、accurae operation indication and skilled operative procedure are the key to improve outcome and reduce the complication.

关 键 词：腰椎间盘突出症 手术治疗 椎板开窗 内窥镜 

分 类 号：R681.53[医药卫生—骨科学]