显微内窥镜腰椎间盘切除术与开放手术的临床疗效比较  

Comparative clinic research on microendoscopic lumbar discectomy and open surgery

作　　者：李刚[1] 

机构地区：[1]宜宾市第一人民医院骨科,四川宜宾644000

出　　处：《西部医学》2011年第8期1456-1457,1460,共3页Medical Journal of West China

摘　　要：目的比较显微内窥镜腰椎间盘髓核摘除术(MED)和标准开放手术,评价MED的临床价值。方法对200例腰椎间盘突出症手术患者进行回顾性比较研究。100例接受MED。同期100例经开放手术。MED采用旁正中小切口,在内镜下完成神经根探查、减压和椎间盘髓核摘除。开放手术采用标准的经椎板间隙开窗、神经根减压和椎间盘髓核摘除。结果 MED组平均随访15个月。开放手术组平均随访19个月。MED组手术后切口疼痛轻,镇痛治疗显著少于开放手术组。采用改良MacNab标准评定随访结果:优75%,良22%,可3%。开放手术组症状改善情况与MED组相似。结论同标准开放手术比较,MED表现相似的短期临床效果,并具有切口小、组织损伤轻和恢复较快的特点,但必须严格掌握适应证。Objective To compare the effect of microendoscopic discectomy and standard open discectomy and assess the clinical value of MED. Methods 100 patients treated with MED and 100 patients treated with standard open discectomy was retrospectively analyzed.MED was performed via a small paracentral approach that allowed thorough root exploration,direct decompression and remove of disc material.This was achieved by applying open surgical tools through a tubular retractor under endoscopic visualization.The endoscopic was inserted by a sequential set of dilators passed over the initial guide wire.Results The two groups were followed up for 15 months and 19 months after operation separately.MED group needed significantly less narcotic medication after surgery.The fellow-up outcomes were evaluated using a modified MacNab criteria,which revealed that 75% of patients were excellent,22% were good,3% were fair in MED group.The open group was similar.Conclusion Compared with the standard open surgery group,MED offer a similar short-term clinical outcome,t with smaller incision,less tissue trauma and quicker recovery.But surgical indication of MED must be mastered strictly.

关 键 词：MED 开放椎间盘髓核摘除术 微创外科 腰椎间盘突出症 

分 类 号：R681.55[医药卫生—骨科学]