后路椎间盘镜与开放椎板开窗髓核摘除术治疗急性腰椎间盘突出症的对比分析  

Comparation of microendoscopic discectomy and open approach in treatment of acute lumbar disc herniation

作　　者：林昱 陈刚[1] 刘文革[1] Lin Yu;Chen Gang;Liu Wenge(Department of Orthopedics,Fujian Medical University Union Hospital,Fuzhou 350001,China)

机构地区：[1]福建医科大学附属协和医院骨科,福州350001

出　　处：《创伤与急诊电子杂志》2021年第3期171-175,共5页Journal of Trauma and Emergency(Electronic Version)

摘　　要：目的比较后路椎间盘镜腰椎髓核摘除术(microendoscopic discectomy,MED)与开放椎板开窗腰椎髓核摘除术(open discectomy,OD)治疗急性腰椎间盘突出症的临床疗效。方法分析2015年1月至2020年1月福建医科大学附属协和医院骨科收治的48例急性腰椎间盘突出症手术患者的资料,其中MED组25例,OD组23例。比较两组患者手术时间、术中出血量、切口长度、术后住院时间、并发症发生率及复发率,并运用疼痛视觉模拟评分法(visual analogue scale,VAS)、日本骨科协会(Japanese Orthopeadic Association,JOA)评估治疗评分、Oswestry功能障碍指数(Oswestry disability index score,ODI)评估两组术后疗效。结果MED组术中出血量、切口长度及术后住院时间均小于OD组,差异有统计学意义(t值分别为7.360、17.364、2.764,P均<0.05),而MED组手术时间多于OD组,差异有统计学意义(t=7.611,P<0.05)。两组术后1周及1年的VAS评分、ODI评分、JOA评分均优于术前,差异有统计学意义(P均<0.05),MED组术后1周及1年VAS评分、ODI评分、JOA评分与OD组相当,差异无统计学意义(P>0.05)。MED组出现1例并发症,OD组出现3例并发症,差异无统计学意义(P>0.05),MED组1例出现术后复发,OD组2例出现术后复发,差异无统计学意义(P>0.05)。结论MED治疗急性腰椎间盘突出症,与OD对比具有创伤小,术后恢复快的优势,两者均能取得较佳疗效及安全性,但在开展早期MED手术时间长于OD。Objective To compare the clinical effects of microendoscopic discectomy(MED)and open discectomy(OD)for lumbar disc herniation.Methods The data of 48 patients with acute lumbar disc herniation admitted to the Department of Orthopedics from January 2015 to January 2020 were analyzed.Among them,25 patients underwent MED and 23 patients underwent OD.Statistical methods were used to compare the operative time,intraoperative blood loss,incision length,postoperative hospital stay,incidence of complications and recurrence rate between the two groups.Visual analog scale(VAS),Japanese Orthopaedic Association(JOA)score and Oswestry Disability Index(ODI)were used to evaluate the postoperative efficacy of the two groups.Results The amount of intraoperative blood loss(48.64±14.60 vs.91.26±24.00,t=7.36),incision length(2.46±0.38 vs.5.12±0.64,t=17.364)and postoperative hospital stay(6.68±1.28 vs.7.83±1.59,t=7.36)in the MED group were lower than those in the OD group,the difference was statistically significant(P<0.05),while the operation time in the MED group was longer than that in the OD group(109.88±19.14 vs.77.22±9.31,t=7.611,P<0.05).VAS score,ODI score and JOA score 1 week and 1 year after surgery in the two groups were better than those before surgery(P<0.05).VAS score,ODI score and JOA score in the MED group 1 week and 1 year after surgery were similar to those in the OD group,but the differences were not statistically significant(P>0.05).One complication occurred in the MED group and 3 complications occurred in the OD group,and the difference was not statistically significant(P>0.05).Postoperative recurrence occurred in 1 case in the MED group and 2 cases in the OD group,and the difference was not statistically significant(P>0.05).Conclusion Compared with OD,MED has the advantages of mini incision and quick postoperative recovery in the treatment of acute lumbar disc herniation.Both of them are effective and safe,but the operation time of MED is longer than that of OD.

关 键 词：后路椎间盘镜髓核摘除术 开放手术 急性腰椎间盘突出症 

分 类 号：R687.3[医药卫生—骨科学]