摘要
目的探讨后路显微内窥镜椎间盘髓核摘除术治疗腰椎间盘突出症患者围手术期手术局部及全身创伤程度的微创性。方法分别记录行显微内窥镜髓核摘除术(微创组)及开放椎板间开窗髓核摘除术(开放组)各22例患者的手术时间、术中出血量、术后住院时间等。比较两组患者术前及术后24、48h血清白细胞介素-6(IL-6)、C-反应蛋白(CRP)浓度以及肌酸激酶(CK)活性水平变化。应用目测类比评分法评估患者术后切口疼痛程度并分别于术前及术后6个月应用汉化Oswestry功能障碍指数量表评估患者症状严重程度及近期临床疗效。结果与开放组比较,微创组手术时间短,术中出血少,术后切口疼痛轻,术后住院时间短,但近期疗效相近。两组血清各指标术前差异无统计学意义,术后24h血清IL-6为(31·6±9·9)^(39·2±11·1)ng/L(P<0·05),CK为(167·9±51·9)^(401·6±108·9)U/L(P<0·01),较术前均明显升高并达最高值,于术后48h浓度下降,其中开放组明显高于微创组。血清CRP浓度在微创组术后24h达最高,而开放组于术后48h浓度达最高(10·8±5·3)^(30·0±14·9)mg/L(P<0·01),术后24、48h微创组CRP浓度均明显低于开放组。结论与开放手术相比,后路显微内窥镜下髓核摘除术术后近期疗效相近,但手术局部肌肉组织损伤轻,患者全身手术创伤反应程度明显低于开放手术,具有微创性。
Objective To compare the traumatic responses following microendoscopic discectomy （MED） and open discectomy. Methods Forty-four patients with single level lumbar disk herniation underwent MED （ Group A, n = 22 ） or open discectomy （ Group B, n = 22 ）. The intra-operational blood loss, duration of operation, intra-operative blood loss, and post-operational hospital stay were noted and the pain severity of incision was evaluated by visual analog scale （VAS）. Serum levels of IL-6, C-reactive protein （CRP） and cratine kinase （CK） were measured before operation and 24h and 48h after operation. The clinical outcomes were evaluated by Oswestry disability index （ODI） before operation and 6 months after operation. Results The intra-operative blood loss of Group A was 47.50 ± 11.62 ml, significantly less than that of Group B （ 129. 11 ±71.75 ml, P 〈0.01 ） , the duration of operation of Group A was 64. 77 ±17.83, significantly shorter than that of Group B （78. 18 ±24. 32, P 〈 0. 05 ）. The postoperative hospital stay of Group A was 6.09 ±2.22 days, significantly shorter than that of Group B （8.73 ± 3.53, P 〈 0.01 ）. The scores of VAS 1, 2, and 3 days after the operation were all significantly lower than those of Group B （ all P 〈0. 001 ）. The rate of remarkable symptomatic improvement of Group A was 94. 7%, not significantly different from that of Group B （ 94. 4%, P 〉 0.05 ） The. serum IL-6 showed no significant difference between these 2 groups pre-operationally, and peaked 24h after operation and decreased 48h after operation in both groups, returning to the pre-operational level in Group A. The IL-6 level 24h and 48h post- operationally of Group A was 31.6 ± 9. 88 pg/ml and 26. 25 ±9. 30 pg/ml respectively, both significantly lower than those of Group B （39. 16 ± 11.14 pg/ml and 32. 55 ±8. 83 pg/ml respectively, both P 〈0. 05 ） The. serum CK showed no significant difference between these 2 groups pre-operationally, and peaked 24h after operation and decreased 48h after operation, but still higher than those before operation, in both groups. The serum CK 24h and 48h after operation of Group A were 167.91 ±51.85 and 131.50 ±52.70 U/L respectively, both significantly lower than those of Group B （401.55 ± 108.86 and 260. 32 ±64. 98 U/ L, both P 〈 0. 01 ）. The. serum CRP level showed no significant difference between these 2 groups preoperationally, and increased post-operationally, peaked 24h after operation and then decreased in Group A, however, continued to increase in Group B. The serum levels of CRP 24 h and 48 h post-operationally of Group A were 12. 68±7.10 and 10. 77 ±5.25 pg/ml, both significantly lower than those of Group B （20. 82 ± 8. 79 and 29.95 ± 14.85 pg/ml, both P 〈 0.01 ）. The clinical outcomes 6 months after operation of these two groups were all satisfying. Conclusion Both MED and open discectomy show good clinical outcomes in treatment of single level lumbar disk herniation, however, the less responses of serum IL-6, CRP, and CK show that the MED procedure is less traumatic.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2006年第43期3039-3042,共4页
National Medical Journal of China
