中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2011年
10期
1138-1143
,共6页
叶树楠%杨述华%邵增务%杨操%许伟华%刘建湘%郜勇%熊蠡茗%冯勇%张波%郭兵
葉樹楠%楊述華%邵增務%楊操%許偉華%劉建湘%郜勇%熊蠡茗%馮勇%張波%郭兵
협수남%양술화%소증무%양조%허위화%류건상%고용%웅려명%풍용%장파%곽병
腰椎%内窥镜检查%椎间盘移位%椎间盘切除术
腰椎%內窺鏡檢查%椎間盤移位%椎間盤切除術
요추%내규경검사%추간반이위%추간반절제술
Lumbar vertebrae%Endoscopy%Intervertebral disk displacement%Diskectomy
目的 对比研究手术显微镜下腰椎间盘切除术(microsurgical lumbar discectomy,MSLD)与椎间盘镜下腰椎间盘切除术(microendoscopic discectomy,MED)治疗单节段腰椎间盘突出症的方法、特点与疗效.方法 2006年1月至2009年12月,900例单节段腰椎间盘突出症患者被随机分为两组,MSLD组与MED组各450例,术后分别平均随访36个月和38个月.比较两组手术病例的平均切口长度、手术时间、出血量、并发症、住院天数及恢复情况.结果 MSLD组及MED组的切口长度分别为(3.8±1.1) cm和(2.4±0.7)cm,手术时间分别为(51.0±14.2) min和(62.0±16.3) min,术中出血量分别为(60±35) ml和(106±43) ml,以上指标两组间差异均有统计学意义(P＜0.05),MSLD组切口长,手术时间和出血量少.MSLD组与MED组的住院天数、恢复正常生活或工作时间之间差异均无统计学意义(P＞0.05).末次随访时,MSLD组及MED组的疼痛视觉模拟评分(visual analogue scales,VAS)改善率和Oswestry功能障碍指数(Oswestry disability index,ODI)改善率差异均无统计学意义(P＞0.05).MSLD组硬脊膜撕裂、急性竖脊肌血肿、神经根及马尾损伤等并发症及术后复发的发生率均明显少于MED组(P＜0.01).两组均未出现定位错误、大血管损伤和术后感染.结论 MSLD与MED治疗单节段腰椎间盘突出症均可获得满意的远期疗效,但MSLD操作简单、并发症少、学习曲线短.
目的 對比研究手術顯微鏡下腰椎間盤切除術(microsurgical lumbar discectomy,MSLD)與椎間盤鏡下腰椎間盤切除術(microendoscopic discectomy,MED)治療單節段腰椎間盤突齣癥的方法、特點與療效.方法 2006年1月至2009年12月,900例單節段腰椎間盤突齣癥患者被隨機分為兩組,MSLD組與MED組各450例,術後分彆平均隨訪36箇月和38箇月.比較兩組手術病例的平均切口長度、手術時間、齣血量、併髮癥、住院天數及恢複情況.結果 MSLD組及MED組的切口長度分彆為(3.8±1.1) cm和(2.4±0.7)cm,手術時間分彆為(51.0±14.2) min和(62.0±16.3) min,術中齣血量分彆為(60±35) ml和(106±43) ml,以上指標兩組間差異均有統計學意義(P＜0.05),MSLD組切口長,手術時間和齣血量少.MSLD組與MED組的住院天數、恢複正常生活或工作時間之間差異均無統計學意義(P＞0.05).末次隨訪時,MSLD組及MED組的疼痛視覺模擬評分(visual analogue scales,VAS)改善率和Oswestry功能障礙指數(Oswestry disability index,ODI)改善率差異均無統計學意義(P＞0.05).MSLD組硬脊膜撕裂、急性豎脊肌血腫、神經根及馬尾損傷等併髮癥及術後複髮的髮生率均明顯少于MED組(P＜0.01).兩組均未齣現定位錯誤、大血管損傷和術後感染.結論 MSLD與MED治療單節段腰椎間盤突齣癥均可穫得滿意的遠期療效,但MSLD操作簡單、併髮癥少、學習麯線短.
목적 대비연구수술현미경하요추간반절제술(microsurgical lumbar discectomy,MSLD)여추간반경하요추간반절제술(microendoscopic discectomy,MED)치료단절단요추간반돌출증적방법、특점여료효.방법 2006년1월지2009년12월,900례단절단요추간반돌출증환자피수궤분위량조,MSLD조여MED조각450례,술후분별평균수방36개월화38개월.비교량조수술병례적평균절구장도、수술시간、출혈량、병발증、주원천수급회복정황.결과 MSLD조급MED조적절구장도분별위(3.8±1.1) cm화(2.4±0.7)cm,수술시간분별위(51.0±14.2) min화(62.0±16.3) min,술중출혈량분별위(60±35) ml화(106±43) ml,이상지표량조간차이균유통계학의의(P＜0.05),MSLD조절구장,수술시간화출혈량소.MSLD조여MED조적주원천수、회복정상생활혹공작시간지간차이균무통계학의의(P＞0.05).말차수방시,MSLD조급MED조적동통시각모의평분(visual analogue scales,VAS)개선솔화Oswestry공능장애지수(Oswestry disability index,ODI)개선솔차이균무통계학의의(P＞0.05).MSLD조경척막시렬、급성수척기혈종、신경근급마미손상등병발증급술후복발적발생솔균명현소우MED조(P＜0.01).량조균미출현정위착오、대혈관손상화술후감염.결론 MSLD여MED치료단절단요추간반돌출증균가획득만의적원기료효,단MSLD조작간단、병발증소、학습곡선단.
Objective To make a comparison between microsurgical lumbar discectomy(MSLD) and microendoscopic discectomy(MED) in terms of methods,feathers,and effectiveness for lumbar disc herniation (LDH).Methods A prospective clinical review was conducted.From January 2006 to December 2009,900patients with single segment lumber disc herniation were randomly divided into the MSLD group and the MED group.There were 450 patients in each group.Comparison would be made in terms of the length of skin incision,the operative time,amount of bleeding,incidence of complication,duration of hospitalization,the time of recovery to ordinary work or life,pre- and post-operative assessment based on the criteria of visual analogue scales (VAS),and the Oswestry disability index(ODI).Results The mean lengths of skin incision were (3.8±1.1) cm and (2.4±0.7) cm for MSLD and MED respectively; the operative time were (51.0±14.2) min and (62.0±16.3) min; and the blood loss were (60±35) ml and (106±43) ml,which showed a significant difference (P＜0.05).There was no significant differences in terms of the hospitalization time and the time of recovery to ordinary work or life between the two groups (P＞0.05).The results of VAS and ODI of two groups also showed no significant difference at final follow-up (P＞0.05).As for the complications,the incidence of dural tear,acute hematomas of sacrospinalis,nerve roots and cauda equina injury and recurrence in MSLD group were much lower than that of MED group (P＜0.01).There was no incidence of wrong segment,greater artery injury,or postoperative infection in each group.Conclusion The clinical effects of both minimal invasive methods are satisfactory.However,MSLD has advantages of simpler maneuvering,shorter learning curve,and less complication than MED.
