内窥镜椎间盘切除术治疗腰椎间盘突出症的疗效观察

摘要

Objecfive To study the clinical results and technical details of posterior microendoscopic discectomy(MED) for the treatment of lumbar disc herniation.Methhods From May 2008 to July 2010,50 cases with lumbar disc herniation underwent the operation with MED,and other 50 patients were treated with standard open discectomy.The clinical outcomes were evaluated by oswestry disability index (ODI) and modified Macnab criteria at the fina1 follow-up before and after the operation.Results The follow-up lasted 3 to 12 months,with a mean duration of 6 months.It cost averagely the patient 10 d for hospitalization,3.5 d to return to general activity,15 d to self care and 5 weeks to return to work.Macnab criteria proved in MED group there were 32 excellent cases(64.0％) and 15 good cases(30.0％) with the excellent and good rate of 94.0％,and in open discectomy group there were 31 excellent cases(62.0％) and 14 good cases(28.0％) with the excellent and good rate of 90.0％.The scores for one-month ODI were between 10 and 19,with the mean value from 75.5to 4.2,which were significantly different from those before the operation with P＜0.01.The ODI scores at the final follow-up of the MED group were(9.43±3.59),which were significantly different from those 1 month after the operation with P＜0.01.When compared with the open discectomy group,MED group was gifted with mild postoperative pain and few pain treatment.Conclusion The posterior microendoscopic discectomy behaves better than the open discectomy on such aspects as surgical trauma,bed rest time,tissue injury and recovery,while its therapeutic effect is similar to that of the open discectomy.%目的:探讨腰椎间盘突出症经后路显微内窥镜(MED)手术治疗的疗效.方法:2008年5月至2010年7月收治的50例腰椎间盘突出症患者采用MED治疗,同期50例采用开放手术.分别与术前、术后、末次随访时进行Oswestrv功能障碍指数(oswestry disability index,ODI)评定,按改良Macnab标准评价临床疗效.结果:术后随访3～12个月,平均6个月.平均住院10d,术后平均3.5 d可下地活动,平均15d生活可自理,5周恢复工作.按Macnab标准疗效评定,MED组优32例(64.0％),良15例(30.0％),优良率为94.0％;开放手术组优31例(62.0％),良14例(28.0％),优良率为90.0％.末次随访MED组ODI为(9.43±3.59)分,与术后1个月比较有显著性差异(P＜0.01).与开放手术组比较,MED组手术后切口疼痛轻,镇痛治疗显著少于开放手术组.结论:经后路椎间盘切除手术创伤小、卧床时间短、恢复快,可以取得与开放手术相近的效果,且具有切口小、组织损伤轻和恢复较快的特点.