摘要:
Objective To compare effect of three dimensional (3D)-viewer spine system and microendoscopic discectomy (MED) in treating lumbar disc herniation.Methods Totally 100 pateints with lumbar disc herniation from January 2011 to January 2012 were randomly divided into 3D group (50 cases) receiving therapy with 3D-viewer spine system and MED group (50 cases) receiving MED surgery.The operation duration, intraoperative bleeding volume, length of hospitalization, total hospitalization expenses and postoperative complications were recorded.The visual analog scales (VAS) and Oswestry disability index (ODI) were assessed before, 1, 6 and 12 months after operation.The pain relief and function improvement preoperation, 3 days , 1 month , 6 months, 12 months postoperation were evaluated by visual analog scale (VAS).Results The operation duration, total hospitalization expenses in 3D group were significantly lower than those in MED group [(46 ± 3) min vs (54 ± 4) min, (7 200 ± 25) yuan vs (8 020 ± 29) yuan];the intraoperative bleeding volume was significantly greater than that in MED group [(52 ± 2) ml vs (44 ± 3) ml] (P <0.05).The length of hospitalization had no statistical difference between the two groups (P > 0.05).The VAS and ODI scores had no significant differences between the two groups before and after operation (P >0.05);3 d, 1,6 and 12 months after operation, the VAS scores and ODI were significantly lower than those before operation in both 3D group [(2.7 ± 0.3), (2.4 ± 0.5), (1.8 ± 0.3),(1.8±0.5) scores vs (6.8±0.4) scores, (34±11)%,(22±12)%, (21 ±18)% vs (67 ±16)%] and MED group [(2.6±0.4), (2.3 ±0.5), (1.7±0.3), (1.7±0.4) scores vs (6.7±0.3) scores, (33±13)%, (22± 11) %, (22 ± 12) % vs (66 ± 18) %] (P < 0.05).Three cases in 3 D group and 2 cases in MED group had delayed wound healing after operation;no infection occurred in both groups.Lumbar disc herniation recurred in 1 case of 3D group 8 months after operation and recovered after treatment;contralateral limb nerve radiation pain occurred in 1 case of MED group 6 months after operation and was improved after treatment.Conclusion 3D-viewer spine system has the similar clinical effect with MED in treating lumbar disc herniation, while the intraoperative bleeding volume is greater, but the operative duration and total cost are lower.%目的 对比三维可调微创拉钩手术系统(3D-viewer)与显微内镜椎间盘切除术(MED)治疗单节段单侧腰椎间盘突出症的临床疗效.方法 分别选择2011年1月至2012年1月于南京明基医院和东南大学附属中大医院骨科就诊的腰椎间盘突出症患者各50例作为3D组和MED组.3D组采用3 D-viewer治疗,MED组采用MED治疗.记录患者手术时间、术中出血量、住院时间、住院总费用、术后并发症发生情况,通过疼痛视觉模拟量表(VAS)及Oswestry功能障碍指数问卷表(ODI)评分记录患者术前、术后3d、1个月、6个月及12个月疼痛程度及功能状况.结果 3D组手术时间、住院总费用明显低于MED组[(46 ±3) min比(54±4) min,(7 200 ±25)元比(8 020 ±29)元],术中出血量大于MED组[(52±2)ml比(44±3)以],2组比较差异有统计学意义(P<0.05).3D组住院时间与MED组比较差异无统计学意义(P>0.05).2组术前及术后各时点VAS和ODI评分比较差异均无统计学意义(均P>0.05).但2组术后3d、1个月、6个月及12个月的VAS评分及术后1、6、12个月的ODI评分均明显低于术前[3D组:(2.7±0.3)、(2.4±0.5)、(1.8±0.3)、(1.8±0.5)分比(6.8±0.4)分,(34±11)%、(22±12)%、(21±18)%比(67±16)%,MED组:(2.6±0.4)、(2.3±0.5)、(1.7±0.3)、(1.7±0.4)分比(6.7±0.3)分,(33±13)%、(22±11)%、(22±12)%比(66±18)%],差异均有统计学意义(均P <0.05).3D组有3例、MED组有2例术后伤口延迟愈合,均无感染发生.3D组有1例于第8个月时腰椎间盘突出复发,治疗后痊愈.MED组有1例术后6个月出现对侧肢体神经放射痛,治疗后好转.结论 3D-viewer和MED治疗单节段单侧腰椎间盘突出症疗效相近,3D组术中出血量较高于MED组,但手术时间及住院花费低于MED组.