显微镜下手术治疗腰椎间盘突出症的临床观察

摘要

目的 观察在手术显微镜下完成腰椎间盘突出髓核摘除术的疗效.方法 分别选取30例住院行显微镜椎间盘切除术( microsurgical lumbar discectomy,MSLD)和传统手术(open lumbar discectomy,OLD)治疗单节段腰椎间盘突出症的患者,比较2种手术的切口长度、手术时间、出血量、住院天数,手术后JOA、VAS和ODI改善率情况.结果 MSLD组及OLD组的切口长度分别为(2.8 ±0.8)cm和(5.5±1.8)cm,手术时间分别为(57.0±16.9)min和(72.0±30.5)min,出血量分别为(85.0±33.0) mL和(110.0±48.0)mL,住院天数分别为(10.2±2.5)d和(12.2±3.6)d,2组间差异有统计学意义(P＜0.01).术后3个月随访时,MSLD组及OLD组的JOA改善率分别为85.3％±8.3％和84.9％±7.6％,VAS改善率分别为86.4％±1.9％和84.4％±2.1％,ODI改善率分别为81.5％±6.3％和80.8％±5.6％,两组间比较差异无统计学意义(P＞0.05).结论 手术显微镜下完成腰椎间盘突出髓核摘除术切口小,术中出血量少,视野清晰,可减少对神经根及硬膜囊的手术刺激,安全、可靠性好,但熟练操作需要较长时间的显微外科训练基础.%Objective To evaluate the efficiency of surgical treatment of lumbar disc herniation by microsurgical lumbar discectomy ( MSLD) . Methods A clinical review was conducted on the two surgical methods for single segment lumbar disc herniation ( LDH) from April 2007 to June 2010, one group of 30 patients who underwent microsurgical lumbar discectomy (MSLD) and the other of 30 patients who underwent open lumbar discectomy ( OLD) . The factors considered included the length of skin incision, the operative time, volume of intraoperative bleeding, duration of hospitalization, pre - and postoperative assessment based on the criteria of Japanese Orthopaedic Association (JOA) Scores, visual analog scale (VAS) , and the Oswestry disability index (ODI). Results The mean length of skin incision was (2. 8 ±0. 8)cm and (5. 5 ± 1. 8)cm, the operative time was (57. 0 ± 16. 9) min and (72. 0 ±30. 5) min, the blood loss was (85.0±33.0) mL and (110.0±48.0) mL, the hospitalization time was (10.2±2.5) days and (12.2±3.6) days for MSLD and OLD respectively. All had significant difference (P<0. 01). Three months after the operation, the improvement rate of JOA was 85. 3% ± 8. 3% and 84. 9% ±7. 6% for MSLD and OLD respectively. The improvement rate of VAS score was 86.4% ± 1. 9% . And 84.4% ± 2. 1 % for MSLD and OLD respectively. The improvement rate of ODI score was 81. 5% ±6.3% and 80. 8% ±5. 6% for MSLD and OLD respectively. None showed any significant difference (P>0. 05). Conclusion MSLD has advantages of little cut, little bleeding, clear surgery field, safety, little hurt to nerve root and dura mater. But skilled operation requires a relatively long period of microsurgery training as foundation.