手术显微镜与放大镜辅助下腰椎间盘摘除技术临床效果的比较  

Clinical results following microsurgical discectomy： comparison of microscope and loupes

作　　者：田伟[1] 韩骁[1] 何达[1] 刘波[1] 李志宇[1] 马赛[1] 于杰[1] 阎凯[1] 靳培浩[1] 

机构地区：[1]北京积水潭医院骨科,100035

出　　处：《中华骨科杂志》2011年第10期1132-1137,共6页Chinese Journal of Orthopaedics

基　　金：北京市科技计划课题（D101100049910008）

摘　　要：目的比较手术显微镜和手术放大镜两种方式辅助下腰椎间盘显微外科摘除技术临床疗效的差别。方法本研究为前瞻性的随机对照研究，包括2007年1月至2010年12月间所有接受显微间盘摘除术的93例患者。通过比较手术显微镜和手术放大镜两种方式辅助下腰椎间盘显微摘除术病例的各种参数，包括住院天数、住院花费、手术时间、估计失血量、手术前后及随访时的日本骨科协会（Japanese Orthopaedic Association，JOA）评分及改善率和Odom’s标准，评估两种手术方法的优劣。结果49例患者接受手术显微镜下手术，44例患者接受手术放大镜下手术。其中80例患者获得门诊或电话随访，随访6．17-52．90个月，平均（29．64-13．05）个月，随访率86．02％。两组患者术前临床资料均无统计学差异，包括年龄、性别、病变节段和术前JOA评分。术后及随访临床资料包括术后JOA评分及改善率、住院天数、住院费用、随访时间和复发率等方面比较差异均无统计学意义，在手术时间、术中出血量、随访JOA评分及改善率方面比较差异均有统计学意义。结论手术显微镜可为手术提供更清晰的视野，可缩短手术时间，减少出血量，降低潜在的神经损伤风险，保留更多的正常组织，获得更好的临床效果。Objective To Compare the clinical results between microscope and loupes which used in microsurgical discectomy. Methods A prospective randomized controlled trial of 93 patients who had undergone microsurgical discectomy from January 2007 to December 2010 was performed. Clinical results were assessed by comparing the following parameters between patients who had undergone the surgery by micro- scope and loupes： length of stay, hospitalization cost, operative time, estimated blood loss, Japanese Orthopaedic Association （JOA） score and JOA recovery rate, Odom＇s standard. Results Forty-nine patients underwent surgery by microscope, and forty-four patients underwent surgery by loupes. Eighty patients received outpatient or telephone follow-up. The follow-up period was 6.17 to 52.90 months with an average of （29.64± 13.05） months, and the follow-up rate was 86.02%. According preoperative data, the two groups didn＇t differ with respect to age, gender, level of radiculopathy, or preoperative JOA score and JOA recovery rate. No sta- tistically significant differences were identified in postoperative JOA score and JOA recovery rate, length of stay, hospitalization cost, length of follow-up, or relapse rate. Statistically significant differences were identified in operative time, estimated blood loss, and follow-up JOA score and JOA recovery rate. Conclusion Microscope can provide relatively more clear and comfortable vision for the surgery. It can short the operative time, decrease blood loss, reduce the potential risk of nerve injury, and retain more normal tissue, which can ensure better clinical results.

关 键 词：椎间盘移位 椎间盘切除术 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]