CAJ | 학술논문

目的：对经皮椎间孔入路内窥镜与传统后路开放手术的临床疗效及微创性进行评估。方法选择2008年10月到2009年4月于我院接受手术的腰椎间盘突出症患者，根据病情及自身选择等因素分为试验组和对照组，试验组采取经皮椎间孔镜下椎间孔入路腰椎间盘切除术，共33例；对照组采取传统后路开放手术，共37例。对两种术式系列指标包括术中出血量、手术持续时间、切口长度、术后下床时间、术后住院天数、并发症，及视觉模拟评分、Macnab评分以及白细胞数、中性粒细胞数、血红细胞沉降率、血浆C反应蛋白、卧位血浆醛固酮、血浆血管紧张素Ⅱ、血浆肾素活性进行测量比较分析，并行统计学处理。结果①试验组较对照组切口小，术中出血量少，住院天数少，手术时间短，术后下床时间早，两组结果差异有统计学意义(P<0．05)。②两组术后1月、末次随访VAS评分和术前相比明显下降，两组术后1月、末次随访VAS评分较术前相比明显升高；两组术前、术后1月、末次随访VAS评分差异无统计学意义( P>0．05)。③试验组Macnab评分，术后1月优良率90．9%，截止末次随访优良率94．0%；对照组，术后1月优良率91．9%，截止末次随访，优良率94．6%。④术后1d、术后5d对照组较试验组血液沉降率、 C反应蛋白、卧位血浆醛固酮、血浆血管紧张素Ⅱ、血浆肾素活性较对照组明显增加，差异无统计学意义(P>0．05)，而白细胞数、中性粒细胞数差异无统计学意义(P>0．05)。结论对经皮椎间孔入路内窥镜治疗腰椎间盘突出症与传统后路开放手术相比切口小，术中出血量少，住院天数少，手术时间短，术后下床时间早、对机体的干扰相对小，应激反应更小，疗效相当。
목적：대경피추간공입로내규경여전통후로개방수술적림상료효급미창성진행평고。방법선택2008년10월도2009년4월우아원접수수술적요추간반돌출증환자，근거병정급자신선택등인소분위시험조화대조조，시험조채취경피추간공경하추간공입로요추간반절제술，공33례；대조조채취전통후로개방수술，공37례。대량충술식계렬지표포괄술중출혈량、수술지속시간、절구장도、술후하상시간、술후주원천수、병발증，급시각모의평분、Macnab평분이급백세포수、중성립세포수、혈홍세포침강솔、혈장C반응단백、와위혈장철고동、혈장혈관긴장소Ⅱ、혈장신소활성진행측량비교분석，병행통계학처리。결과①시험조교대조조절구소，술중출혈량소，주원천수소，수술시간단，술후하상시간조，량조결과차이유통계학의의(P<0．05)。②량조술후1월、말차수방VAS평분화술전상비명현하강，량조술후1월、말차수방VAS평분교술전상비명현승고；량조술전、술후1월、말차수방VAS평분차이무통계학의의( P>0．05)。③시험조Macnab평분，술후1월우량솔90．9%，절지말차수방우량솔94．0%；대조조，술후1월우량솔91．9%，절지말차수방，우량솔94．6%。④술후1d、술후5d대조조교시험조혈액침강솔、 C반응단백、와위혈장철고동、혈장혈관긴장소Ⅱ、혈장신소활성교대조조명현증가，차이무통계학의의(P>0．05)，이백세포수、중성립세포수차이무통계학의의(P>0．05)。결론대경피추간공입로내규경치료요추간반돌출증여전통후로개방수술상비절구소，술중출혈량소，주원천수소，수술시간단，술후하상시간조、대궤체적간우상대소，응격반응경소，료효상당。
Objective To study of clinical application between this surgery and general fenestration operation. Methods 33 cases treated by lumbar discectomy via percutaneous endoscopic approach and 37 cases treated by general fenestration. The inde-xes of these two surgical methods such as peroperative bleeding, operation time, length of incision, postoperative activity out of bed days, postoperative hospital stay, complications were evaluated by using visual analogue score, Lehmann lumbar functional rating score, Macnab score. Leukocyte count, neutrophil counts, erythrocyte sedimentation rate, plasma C-reactive protein, plasma aldo-sterone, angiotensin Ⅱ, plasma renin activity were measured out for comparison and statistic analysis. Results ①In clinical opera-tion, compared with control group, experiment group has small incision, less blood loss, short hospitalization time, short operative time and off-bed early. The results of the two group were different significantly. ②The two groups in 1 month postoperative and latest follow-up, the lumbar functional rating score, VAS score different significantly compared with pre-operation. But the score had no significant differences between experiment group and control group in pre-operation, 1 month post-operation and latest follow-up re-spectively. ③In experiment group, the excellent rate was 90. 9% in 1 month post-operation and 94% in latest follow-up. In control group, the excellent rate was 91. 9% in 1 month post-operation and 94. 6% in latest follow-up. ④In the 1st and 5th day after the op-erations, erythrocyte sedimentation rate, plasma C-reactive protein, plasma aldosterone, angiotensinⅡand plasma renin activity in-creased markedly in control group compared with experiment group, the results were different significantly while Leukocyte count and neutrophil counts have no statistical difference. Conclusion Compared with control group, experiment group has small incision, less blood loss, short hospitalization time, short operative time, off-bed early,interference on the body relatively small and less stress re-action,but therapeutic equivalence.