经微创通道精确开窗治疗腰椎椎间盘突出症  

Precise open-window discectomy with assistance of tubular retraction system for lumbar disc herniation

作　　者：沈军[1] 邹天明[1] 杨惠林[2] 陈广祥[1] 蔡晓强[1] 成亮[1] 朱国清[1] 王东来[1] 

机构地区：[1]南京医科大学附属苏州医院,苏州市立医院骨科,江苏215002 [2]苏州大学附属第一医院骨科,江苏215006

出　　处：《脊柱外科杂志》2016年第3期140-144,共5页Journal of Spinal Surgery

基　　金：江苏省卫生厅面上项目科研课题(H201346);苏州市医学重点学科资助课题(Szxk201509)

摘　　要：目的比较腰椎椎间盘突出症经微创通道精确开窗与经传统开放入路行单纯髓核摘除术的中期临床疗效。方法 2009年12月—2012年5月,南京医科大学附属苏州医院收治的腰椎椎间盘突出症患者72例,其中经微创通道手术(A组)38例,传统开放手术(B组)34例,术后经过≥36个月的随访;统计手术相关参数和并发症,影像学判断脊柱稳定性,采用疼痛视觉模拟量表(VAS)评分、日本骨科学会(JOA)评分、Oswestry功能障碍指数(ODI)和Spangfort标准对患者进行评估,了解微创通道下精确开窗髓核摘除术的优越性。结果 A组平均手术切口长度和出血量与B组相比,差异具有统计学意义(P<0.05);B组出现椎间隙定位错误2例,腰椎不稳1例,其余并发症2组相似。2组患者所有术后评分均较术前显著改善;各随访时间点B组腰痛VAS评分均显著高于A组;腿痛VAS评分组内和组间比较,差异均无统计学意义(P>0.05)。术后JOA评分和ODI随着随访时间延长,功能逐渐改善,组内各随访时间点之间比较,差异均无统计学意义(P>0.05);组间比较,A组术后评分优于B组,差异具有统计学意义(P<0.05)。按Spangfort评分标准,A组"优"的比例显著高于B组,差异具有统计学意义(P<0.05)。结论微创通道下精确开窗髓核摘除术,在对椎间隙进行有效处理的同时可以很好地保护脊柱的稳定性,并去除合并骨性压迫的因素,进一步提高了单纯髓核摘除术的临床疗效。Objective To compare the mid-term clinical efficacy of traditional discectomy with precise open-window discectomy assisted by tubular retraction system for lumbar disc herniation. Methods From December 2009 to May 2012,34 cases were operated with traditional discectomy（Group A） and 38 cases with precise open-window discectomy assisted by tubular retraction system（Group B）. The least follow-up period was 36 months. The operation-related parameters,complications,the spinal stability through imaging evaluation,visual analogue scale（VAS） score,Japanese Orthopaedic Association（JOA） score,Oswestry disability index（ODI）,Spangfort criteria were recorded and statistically analyzed,which were used to understand the superiority of mini-invasive tubular technique. Results There were significant diffenrences of the mean incision length and blood loss between the 2 groups（P〈0.05）. Two cases with the wrong position of operative intervertebral space and 1 case with lumbar distability in Group B,and the other complications were similar in 2 groups. Both groups had significant improvement of VAS score,JOA score,ODI and Spangford score compared with those of pre-operation. The low back pain VAS score in Group B was significantly higher than that of Group A during follow-up,and the leg pain VAS score had no significant difference within and between 2 groups（P〈0.05）. The JOA score and ODI gradually improved during follow-up period,and there was no significant difference within each group between different follow-up timings（P〈0.05）. The ratio of＂excellent＂according to Spangfort criteria in Group A was significantly higher than that of Group B. Conclusion Precise open-window discectomy assisted by tubular retraction system can protect the stability of spine,and also can remove the bony factor of compression in the treatment of lumbar disc herniation. It further improves the clinical efficacy of simple disectomy.

关 键 词：腰椎 椎间盘移位 椎间盘切除术 经皮 外科手术 微创性 

分 类 号：R683.2[医药卫生—骨科学]