摘要
目的:比较经皮内窥镜下腰椎间盘切除术(PELD)与后路显微内窥镜下腰椎间盘切除术(MED)治疗腰椎间盘突出症(LDH)的临床疗效。方法:采用前瞻性随机对照研究的方法,选取2012年2月-2013年6月90例术前确诊为单节段腰椎间盘突出症的患者,随机分为PELD组和MED组各45例,采用视觉模拟量表(VAS)评分和Oswestry功能障碍指数(ODI)评估疗效。结果:所有患者均顺利完成手术。PELD组平均术中透视次数16.4次,切口长度8.5mm,手术时间88.3min,手术失血10.8mL,术后卧床5.9h,住院3.6d;MED组平均术中透视次数2.5次,切口长度16.4mm,手术时间51.4min,手术失血32.8mL,术后卧床73.1h,住院6.5d。PELD组较MED组术中透视次数更多、手术时间更长,差异具有统计学意义(P<0.05);但在手术切口长度、手术出血量、术后卧床时间和住院时间的比较上,PELD组优于MED组,差异具有统计学意义(P<0.05)。两组术后VAS、ODI评分与术前比较,均明显改善(P<0.05),两组之间VAS评分、ODI评分术后改善率比较差异无统计学意义(P>0.05)。结论:在严格选择手术适应证的情况下,PELD和MED均具有安全有效、手术创伤小、出血量少、并发症发生率低、术后恢复快等优点,但是PELD是一种更加理想的微创手术。
Objective：To compare the clinical outcomes of percutaneous endoscopic lumbar discectomy（PELD） and microendoscopic discectomy （MED） in the treatment of lumbar disc herniation（LDH） ,and further to summarize the clinical experience. Methods：A prospective randomized controlled study was performed on 90 patients who were diagnosed preoperatively as single lumbar disc herniation from February 2012 to June 2013 were randomly divided into 2 groups, with 45 patients in each group. The Visual Analogue Scale （ VAS ） and Oswestry Disability Index （ODI） were used to evaluate the clinical outcomes. Results：All the patients went through the operation successfully. The mean frequency of intraoperative X-ray exposure for the patients in the PELD group was 16.4, with an average length of operative incision was 8.5mm, a mean op- eration time was 88.3min,and an average blood loss of 10.8ml. Postoperatively they were kept in bed for a mean period of 5.9h, with an average hospitalization duration of 3.6d. While for the patients in the MED group, the mean frequency of intraoperative X-ray exposure was 2.5, an average length of operative incision was 16.4mm, the mean operation time was 51. 4min,and the average blood loss was 32.8ml,Postoperatively they were kept in bed for a mean period of 73. 1h, with an average hospitalization duration of 6.5d. The frequency of intraoperative X-ray exposure was more and the operation time was longer in the PELD group than those in the MED group, and the differences between them were statistically significant（P 〈0.05）. However, the PELD group was superior to the MED group, with less incision length, less blood loss, less time in bed and shorter hospital stays, and the differences between them were statistically significant（P〈0.05）. All patients were followed up for a mean period of 15.3months. The VAS and ODI scores were significantly improved postoperatively in both groups when compared with those preoperatively（P〈0.05）. However, the rates of improvement in the VAS and ODI scores between the 2 groups were not significantly different（P〈0.05）. Conclusion： In the case of the patients are selected strictly according to the indications,both PELD and MED have the advantages of safety, effectively,minimal invasion, less blood loss,low complication rate, quicker postoperative recovery and so on. Compared with MED, PELD is a more ideal minimally invasive surgery.
出处
《中国中医骨伤科杂志》
CAS
2014年第7期29-32,共4页
Chinese Journal of Traditional Medical Traumatology & Orthopedics
关键词
椎间盘移位
腰椎
微创性
椎间盘切除术
经皮内窥镜
显微内窥镜
Intervertebral disk displacement
Lumbar vertebrae
Surgical procedure
Minimally invasive
Discectomy
Percutaneous endoscopic
Microendoscopic
