中国骨与关节杂志
中國骨與關節雜誌
중국골여관절잡지
Chinese Journal of Bone and Joint
2013年
1期
30-35
,共6页
刘昊楠%林欣%闫家智%王磊%崔维%曾峥
劉昊楠%林訢%閆傢智%王磊%崔維%曾崢
류호남%림흔%염가지%왕뢰%최유%증쟁
经椎间孔%内窥镜%显微镜%微创治疗%腰椎间盘突出症
經椎間孔%內窺鏡%顯微鏡%微創治療%腰椎間盤突齣癥
경추간공%내규경%현미경%미창치료%요추간반돌출증
Transforaminal%Endoscope%Microscope%Minimally invasive treatment%Lumbar disc herniation (LDH)
目的比较经皮椎间孔镜与显微镜下手术治疗腰椎间盘突出症(LDH)的近期临床疗效及对腰椎稳定性的影响,总结临床经验.方法回顾性分析2010年8月至2011年9月期间在我科接受手术治疗的单节段LDH患者106例,其中接受经皮椎间孔镜腰椎间盘切除术(PTED)患者48例,接受显微镜下腰椎间盘切除术(MSLD)患者58例.比较两种手术切口长度、手术时间、出血量、住院天数及花费、恢复工作时间及返岗率、并发症、二次手术情况.手术效果按照视觉疼痛模拟评分(visual analogue scale,VAS)、JOA评分(Japanese Orthopaedic Association Scores)、Oswestry功能障碍指数(oswestry disability index,ODI)和改良MacNab标准进行评定.末次随访时通过测量比较患者术前、术后腰椎曲度(Cobb角)、椎间水平位移和角位移评估腰椎稳定性变化.结果 PTED组及MSLD组的切口长度、出血量、住院天数及花费、恢复工作时间组间比较均差异有统计学意义(P<0.01),手术时间及返岗率差异无统计学意义(P>0.05).PTED组和MSLD组并发症发生率分别为:6.3%(3/48)和20.7%(12/58),PTED组少于MSLD组(P<0.01).3例患者行PTED失败或术后复发,择期行MSLD后症状缓解.PTED组和MSLD组患者术后随访时间平均为16.7个月和17.3个月,两组术后各随访时间点腰腿痛VAS评分、JOA评分、ODI指数较术前均明显改善(P<0.01),但MSLD组术后3个月内腰痛VAS评分均高于PTED组.PTED组和MSLD组患者末次随访时按改良Macnab标准评定优良率分别为:91.4%和92.3%,组间比较差异无统计学意义(P>0.05).PTED组患者术前、术后腰椎曲度无明显变化(P>0.05);MSLD组患者术后腰椎曲度较术前减小(P<0.05),两组患者术后均未出现腰椎失稳.结论 PTED与MSLD治疗单节段腰椎间盘突出症均可取得满意的近期临床疗效.但PTED具有创伤小、出血少和恢复快等特点,对患者腰椎稳定性影响较小,是更为理想的微创手术方法.
目的比較經皮椎間孔鏡與顯微鏡下手術治療腰椎間盤突齣癥(LDH)的近期臨床療效及對腰椎穩定性的影響,總結臨床經驗.方法迴顧性分析2010年8月至2011年9月期間在我科接受手術治療的單節段LDH患者106例,其中接受經皮椎間孔鏡腰椎間盤切除術(PTED)患者48例,接受顯微鏡下腰椎間盤切除術(MSLD)患者58例.比較兩種手術切口長度、手術時間、齣血量、住院天數及花費、恢複工作時間及返崗率、併髮癥、二次手術情況.手術效果按照視覺疼痛模擬評分(visual analogue scale,VAS)、JOA評分(Japanese Orthopaedic Association Scores)、Oswestry功能障礙指數(oswestry disability index,ODI)和改良MacNab標準進行評定.末次隨訪時通過測量比較患者術前、術後腰椎麯度(Cobb角)、椎間水平位移和角位移評估腰椎穩定性變化.結果 PTED組及MSLD組的切口長度、齣血量、住院天數及花費、恢複工作時間組間比較均差異有統計學意義(P<0.01),手術時間及返崗率差異無統計學意義(P>0.05).PTED組和MSLD組併髮癥髮生率分彆為:6.3%(3/48)和20.7%(12/58),PTED組少于MSLD組(P<0.01).3例患者行PTED失敗或術後複髮,擇期行MSLD後癥狀緩解.PTED組和MSLD組患者術後隨訪時間平均為16.7箇月和17.3箇月,兩組術後各隨訪時間點腰腿痛VAS評分、JOA評分、ODI指數較術前均明顯改善(P<0.01),但MSLD組術後3箇月內腰痛VAS評分均高于PTED組.PTED組和MSLD組患者末次隨訪時按改良Macnab標準評定優良率分彆為:91.4%和92.3%,組間比較差異無統計學意義(P>0.05).PTED組患者術前、術後腰椎麯度無明顯變化(P>0.05);MSLD組患者術後腰椎麯度較術前減小(P<0.05),兩組患者術後均未齣現腰椎失穩.結論 PTED與MSLD治療單節段腰椎間盤突齣癥均可取得滿意的近期臨床療效.但PTED具有創傷小、齣血少和恢複快等特點,對患者腰椎穩定性影響較小,是更為理想的微創手術方法.
목적비교경피추간공경여현미경하수술치료요추간반돌출증(LDH)적근기림상료효급대요추은정성적영향,총결림상경험.방법회고성분석2010년8월지2011년9월기간재아과접수수술치료적단절단LDH환자106례,기중접수경피추간공경요추간반절제술(PTED)환자48례,접수현미경하요추간반절제술(MSLD)환자58례.비교량충수술절구장도、수술시간、출혈량、주원천수급화비、회복공작시간급반강솔、병발증、이차수술정황.수술효과안조시각동통모의평분(visual analogue scale,VAS)、JOA평분(Japanese Orthopaedic Association Scores)、Oswestry공능장애지수(oswestry disability index,ODI)화개량MacNab표준진행평정.말차수방시통과측량비교환자술전、술후요추곡도(Cobb각)、추간수평위이화각위이평고요추은정성변화.결과 PTED조급MSLD조적절구장도、출혈량、주원천수급화비、회복공작시간조간비교균차이유통계학의의(P<0.01),수술시간급반강솔차이무통계학의의(P>0.05).PTED조화MSLD조병발증발생솔분별위:6.3%(3/48)화20.7%(12/58),PTED조소우MSLD조(P<0.01).3례환자행PTED실패혹술후복발,택기행MSLD후증상완해.PTED조화MSLD조환자술후수방시간평균위16.7개월화17.3개월,량조술후각수방시간점요퇴통VAS평분、JOA평분、ODI지수교술전균명현개선(P<0.01),단MSLD조술후3개월내요통VAS평분균고우PTED조.PTED조화MSLD조환자말차수방시안개량Macnab표준평정우량솔분별위:91.4%화92.3%,조간비교차이무통계학의의(P>0.05).PTED조환자술전、술후요추곡도무명현변화(P>0.05);MSLD조환자술후요추곡도교술전감소(P<0.05),량조환자술후균미출현요추실은.결론 PTED여MSLD치료단절단요추간반돌출증균가취득만의적근기림상료효.단PTED구유창상소、출혈소화회복쾌등특점,대환자요추은정성영향교소,시경위이상적미창수술방법.
Objective To compare the preliminary clinical efficacy of percutaneous transforaminal endoscopic discectomy (PTED) and microsurgical lumbar discectomy (MSLD) for lumbar disc herniation (LDH) and their effects on lumbar spinal stability, and further to summarize the clinical experience. Methods The data of 106 patients with single segment LDH who were adopted by our department from August 2010 to September 2011 were retrospectively studied. All patients were divided into 2 groups, including 48 patients undergoing PTED and 58 patients undergoing MSLD respectively. The factors including the length of skin incision, operation time, amount of intraoperative bleeding, duration and cost of hospitalization, time and rate of returning to work, complications and second operation were compared. The visual analogue scale (VAS), Japanese Orthopedic Association (JOA) scores, Oswestry Disability Index (ODI) and modified MacNab criteria were used to measure the clinical outcomes. In the latest follow-up, the changes in lumbar spinal stability were evaluated by measuring and comparing lumbar curves (Cobb’s angle), horizontal displacement (HD) and angular displacement (AD) before and after surgery. Results There were significant differences in the observation factors such as the skin incision length, amount of intraoperative bleeding, duration and cost of hospitalization and time of returning to work between the PTED and MSLD groups (P<0.01), without significant differences in operation time and rate of returning to work (P>0.05). The incidence of complications in the PTED group was 6.3%(3/48), which was less than 20.7%of the MSLD group (12/58) (P<0.01). PTED failed or postoperative recurrence occurred in 3 cases, and then MSLD was performed to improve the symptoms. After surgery, the patients in both groups were followed up for 16.7 months and 17.3 months on average respectively. The postoperative back and leg pain VAS scores, JOA scores and ODI at each follow-up time point in both groups were significantly improved when compared with the preoperative ones (P<0.01). However, 3 months after surgery back pain VAS scores in the MSLD group were higher than that in the PTED group. According to the modified MacNab criteria, the excellent and good rates were 91.4%and 92.3%respectively in the PTED and MSLD groups in the latest follow-up, and the differences between the 2 groups were not statistically significant (P>0.05). There was no significant difference in lumbar curves before and after surgery for the patients in PTED group (P>0.05), and the postoperative lumbar curves in MSTD group decreased when compared with that before surgery (P<0.05). Postoperatively none of the patients complained about lumbar spinal instability. Conclusions The preliminary clinical efficacy of both PTED and MSLD in the treatment of single segment LDH is satisfactory. However, PTED is a better minimally invasive surgical method with such advantages as less trauma, less blood loss, early function recovery, less effect on lumbar spinal stability and so on.
