CAJ | 학술논문

目的比较单切口显微内窥镜下椎间盘切除术（MED）与传统开放椎间盘切除术（OD）治疗双节段腰椎间盘突出症的临床疗效。方法2009年1月至2011年1月在我科接受椎间盘切除手术的双节段腰椎间盘突出症患者，共25例，入院时随机分为MED组（n＝12）和OD组（n＝13），分析比较两组患者的手术时间、麻醉时间、住院时间、住院费用、术中出血量、摘除椎间盘重量、手术切口长度、Oswestry评分的改善情况以及临床效果满意率。结果MED组的手术时间、麻醉时间明显高于OD组（P＜0.05），MED组的术中出血量、切口长度、术后下床时间、住院时间、住院费用等明显小于OD组（P＜0.05）。两组术中摘除髓核组织重量无明显差别（P＞0.05）。和术前相比，术后MED组和OD组的Oswestry评分具有明显改善，但术前和术后两组间均无明显差别（P＞0.05）。两组间临床效果满意率无明显差异（P＞0.05）。结论对于双节段腰椎间盘突出症患者，OD和单切口MED均是有效的治疗方法。但单切口MED术中出血量少、切口长度小、术后下床时间早、住院时间短、住院费用低，更加符合微创理念。
목적비교단절구현미내규경하추간반절제술（MED）여전통개방추간반절제술（OD）치료쌍절단요추간반돌출증적림상료효。방법2009년1월지2011년1월재아과접수추간반절제수술적쌍절단요추간반돌출증환자，공25례，입원시수궤분위MED조（n＝12）화OD조（n＝13），분석비교량조환자적수술시간、마취시간、주원시간、주원비용、술중출혈량、적제추간반중량、수술절구장도、Oswestry평분적개선정황이급림상효과만의솔。결과MED조적수술시간、마취시간명현고우OD조（P＜0.05），MED조적술중출혈량、절구장도、술후하상시간、주원시간、주원비용등명현소우OD조（P＜0.05）。량조술중적제수핵조직중량무명현차별（P＞0.05）。화술전상비，술후MED조화OD조적Oswestry평분구유명현개선，단술전화술후량조간균무명현차별（P＞0.05）。량조간림상효과만의솔무명현차이（P＞0.05）。결론대우쌍절단요추간반돌출증환자，OD화단절구MED균시유효적치료방법。단단절구MED술중출혈량소、절구장도소、술후하상시간조、주원시간단、주원비용저，경가부합미창이념。
Objective To compare the outcomes of microendoscopic discectomy ( MED ) by single-incision versus open discectomy ( OD) for double-segmental lumbar disc herniation .Methods From January 2009 to January 2011 ,25 patients with a double-segmental lumbar disc herniation were randomized to undergo MED ( n =12 ) by single-incision or OD(n=13).The 2 groups were compared with respect to surgical time ,anaesthesia time,duration of hospital stay ,intra-operative blood loss ,weight of disc material removed ,length of operative incision ,improvement in Oswestry score and satisfaction rate of clinical outcome .Results Surgical and anaesthesia times were significantly longer(P<0.05),but blood loss,length of operative incision,time of postoperative bed rest,hospital stay and cost were significantly reduced in MED group than OD group ( P<0.05 ) .The weight of disc material removed was similar between the two groups ( P >0.05 ) .The improvement in Oswestry score in both groups were significant after the operation,but Oswestry score were similar in both groups ( P >0.05 ).Satisfaction rate of clinical outcome were similar in both groups ( P>0.05 ) .Conclusions Both methods are equally effective in treating double-segmental lumbar disc herniation.However,MED by single-incision entailed less intra-operative blood loss,shorter length of operative incision ,less time of postoperative bed rest and hospital stay , less hospital cost , which consists with the demand of minimal invasion .