摘要
目的探讨微创通道髓核摘除术治疗腰椎间盘突出症的效果。方法回顾性分析2015年6月~2017年3月我院38例微创通道髓核摘除术及35例传统半椎板切除髓核摘除术资料,根据患者意愿选择治疗方法。比较2组手术指标,术前及术后1天、1个月、5个月、10个月进行腰痛视觉模拟评分(Visual Analogue Scale,VAS)、Oswestry功能障碍指数(Oswestry Disability Index,ODI)、日本骨科协会(Japanese Orthopedic Association,JOA)评分,用改良MacNab标准评估疗效。结果微创组手术时间、术中出血量、下床活动时间、术后住院时间均显著优于传统组[(45.0±6.3)min vs.(82.5±20.2)min,t=-10.547,P=0.000;(23.1±5.7)ml vs.(57.6±13.4)ml,t=-14.143,P=0.000;(2.8±0.8)d vs.(5.4±1.1)d,t=-11.197,P=0.000;(6.4±1.6)d vs.(15.3±2.4)d,t=-19.187,P=0.000],微创组并发症发生率低于传统组,但差异无显著性(P>0.05)。2组术前VAS、ODI、JOA评分差异均无显著性(P>0.05);2组术后各时点VAS、ODI、JOA评分均显著优于术前(P<0.05),且微创组优于传统组(P<0.05)。术后10个月采用改良MacNab标准评价,微创组优、良、可、差分别为24、13、1、0例,传统组为16、12、7、0例,微创组优良率(97.4%,37/38)明显高于传统组(80.0%,28/35)(χ^2=3.993,P=0.046)。结论与传统半椎板切除髓核摘除术相比,微创通道髓核摘除术治疗腰椎间盘突出创伤小,恢复快,有助于神经功能恢复,临床疗效较好。
Objective To investigate the clinical effect of discectomy by minimally invasive approach for lumbar disc herniation.Methods A retrospective analysis selected information of 38 patients who were treated with discectomy by minimally invasive approach and 35 patients who were treated with discectomy by traditional hemi-laminectomy from June 2015 to March 2017.The treatment method was selected according to the patient’s wishes.Surgical index was compared between the two groups.The pain Visual Analogue Score(VAS),Oswestry Dysfunction Index(ODI),and Japanese Orthopedic Association(OA)scores were compared in the two groups before and after surgery at 1 day,1 month,5 months and 10 months.The efficacy was evaluated by using modified MacNab criteria.Results The operation time,intraoperative bleeding volume,time of getting out of bed and hospital stay in the minimally invasive group were significantly better than those in the traditional group[(45.0±6.3)min vs.(82.5±20.2)min,t=-10.547,P=0.000;(23.1±5.7)ml vs.(57.6±13.4)ml,t=-14.143,P=0.000;(2.8±0.8)d vs.(5.4±1.1)d,t=-11.197,P=0.000;(6.4±1.6)d vs.(15.3±2.4)d,t=-19.187,P=0.000].The incidence of complications in the minimally invasive group was less than that in the traditional group but no statistical difference was found(P>0.05).There were no significant differences in preoperative VAS,ODI,and JOA scores between the two groups(P>0.05).The VAS,ODI,and JOA scores of each time point after operation in the two groups were significantly better than those before operation(P<0.05),and scores of the minimally invasive group were better than the traditional group(P<0.05).The modified MacNab criteria was used at 10 months after operation.the excellent,good,acceptable and poor results in the minimally invasive group were 24 cases,13 cases,1 case,and 0 case,and in the traditional group were 16 cases,12 cases,7 cases,and 0 case,respectively.The excellent and good rate of minimally invasive group(97.4%,37/38)was significantly higher than that of traditional group(80.0%,28/35;χ^2=3.993,P=0.046).Conclusion Compared with discectomy by traditional hemi-laminectomy,discectomy by minimally invasive approach in the treatment of lumbar disc herniation patients has advantages of less intraoperative trauma,more rapid recovery,more helpful to restore nerve function,and better clinical efficacy.
作者
马志锋
贺宪
陈炳泉
Ma Zhifeng;He Xian;Chen Bingquan(Department of Orthopaedics, Panyu Traditional Chinese Medicine Hospital, Guangzhou 511400, China)
出处
《中国微创外科杂志》
CSCD
北大核心
2020年第9期802-806,共5页
Chinese Journal of Minimally Invasive Surgery
关键词
腰椎间盘突出症
微创通道髓核摘除术
Lumbar disc herniation
Minimally invasive approach discectomy
