手术显微镜下与椎间盘镜下治疗腰椎间盘突出症的比较研究

摘要

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.%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.