摘要
目的:分析比较显微内镜椎间盘髓核摘除术(MED术)和小切口开窗减压髓核摘除术治疗腰椎间盘突出症的临床疗效,探讨两种术式治疗腰椎间盘突出症的优点及适用范围。方法:对资料完整的110例行MED术或小切口手术的腰椎间盘突出症患者的资料进行分析,其中MED术(MED组)56例,男37例,女18例,平均年龄39.6岁(28～63岁),病变节段:L4-530例,L5S123例,L4-5、L5S1双节段3例;小切口术(小切口组)54例,男29例,女25例,平均年龄42.3岁(26～73岁),病变节段:L4-527例,L5S121例,L4、5、L5S1双节段6例。比较两种治疗方法在手术切口长度、手术时间、术中出血量、术后卧床时间、镇痛药使用、平均住院日、临床疗效等指标。结果:MED组和小切口组的平均随访时间分别为13.5、15.3个月,MED组与小切口组比较,手术切口长度、术中出血量、术后卧床时间、镇痛药使用、平均住院日均显著少于小切口组,但手术时间长于小切口组,两组差异具有显著意义(P<0.05)。临床疗效参照Macnab标准评定,MED组:优37例,良13例,可6例;小切口组:优33例,良12例,可6例;两组疗效比较无显著性差异(P>0.05)。结论:同小切口手术比较,MED术具有切口小、组织损伤轻、恢复快等优点,小切口手术也具有其优势及适应症,临床应用中应掌握手术指征,采用合理术式,以获得最佳疗效。
Objective ：To compare the clinical effect of micro -endoscopic discectomy （MED） and small -incision dis- cectomy in lumbar discherniation treatment and investigate the advantage and application-of the two methods. Methods： Totally 110 lumbar discherniation patients were investigated, including 56 MED （ 37 male and 18 ：female ; mean age ： 39. 6 years; range 28 -63 years; the segment of herniated discs were at L4_5 in 30, at LsS1 in 23and at L4_5 ,LsS1 in 3 ） and 54 small - incision discectomy （ 29 male and 25 female ; mean age 42. 3 years ; range 26 - 73 years ; the segment of herniated discs were at L4,5 in 27, at LsSl in 21 and at L4.5 .,LsS1 in 6）. The clinical result, the incision length, the operative time, the blood loss in operation, the postoperative bed time, the narcotic medication dosage after operation and the average.hospital time are selected for researching indices. Results：The average duration of follow - up for MED and small - incision discectomy was 13.5 and 15.3 months respectively. The group of MED have shorter incision length, smaller blood loss in operation, less postoperative bed and average hospital time, less narcotic medication use after opera- tion and longer operative time compared with the group of small - incision discectomy （ P 〈 O. 05 ）. According to modified Macnab criteria, MED group have 37 excellences, 13 goods and 6 fairs; Small - incisioin discetomy group have 33 excel-lences, 12 goods and 6 fairs （P 〉 0.05 ）. Conclusions：Comparing with small - incision discectomy group, MED is of smaller incision, less tissue trauma and quicker recovery. The small - incision discectomy operation also has its advanta- ges and indications, which could obtain the best clinical result base on adaptive management for the patients＇ condition.
出处
《航空航天医学杂志》
2012年第12期1447-1449,共3页
Journal of Aerospace medicine
关键词
椎间盘突出症
内窥镜
外科手术
Lumbar discherniation
Endoscopes
Surgical procedures
