椎间盘镜与开放手术治疗腰椎间盘突出症临床疗效分析(1)
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【摘要】 目的 比较后路椎间盘镜髓核摘除术(
microendoscopic discectomy，MED)与开放椎板开窗(open discectomy，OD)治疗腰椎间盘突出症的临床效果及优缺点。方法 回顾性分析手术治疗96例腰椎间盘突出症(椎间盘镜组、开放椎板开窗组各48例)，分别比较两组手术时间、总出血量、黄韧带和椎板咬除量、住院时间、VAS评分；术后随访按Nakai评分统计术后优良率。结果 椎间盘镜组和开放椎板开窗组术后优良率差异无统计学意义，两组在总出血量、黄韧带和椎板咬除量、术后住院时间差异有统计学意义，椎间盘镜组优于开放手术组。结论 椎间盘镜与开放椎板开窗术均能缓解腰椎间盘突出症症状，但椎间盘镜具有切口小、组织损伤轻、恢复较快的优点。
【关键词】
椎间盘镜髓核摘除术；开放椎板开窗；腰椎间盘突出症
A comparative study of microendoscopie discectomy and open discectomy for lumbar dischermiation
JIANG Zhenshuai,JIANG Guangming,CHEN Minghu
Department of Orthopaedics，the People’s hospital of JiangHua County，Hunan Yongzhou 425500，China
【Abstract】 Objective To compare the clinical therapeutic effects as well as advantages and disadvantages of microendoscopic discectomy(MED)and open discectomy (OD) Methods A restrospective study was carried out in a series of 96 patients (48 treated by MED and 48 by OD)treated from January 2006 to January 2009The operation time，the total amount of bleeding，the quantity of yellow ligament biteand lamina bite and duration of hospitalization after operation and VASwere compared The rate of excellent and good outcomes were evaluated according to Nakai criterian Results Significant difference was found between MED group and OD group in bleeding，the quantity of yellow ligament biteand lamina bite and duration of hospital after operation Conclusion Compared with the OD，MED has advantages such as smaller incision，mild damage of tissues，bleeding less，quicker recovery By both methods，the clinical outcomes are similar in the treatment to relieve the symptoms of the lumbar dischemiation
【Key words】
Microendoscopic discectomy；Open discectomy；Lumbar dischermiation
腰椎间盘突出症(LDH)是因椎间盘退变、破裂、突出，压迫或刺激相邻组织所出现的综合征，系骨科常见疾病，患者可有严重的腰腿痛，影响其生活质量。对于部分经保守治疗无效的患者，需要接受手术治疗。以往LDH都是采用开放的手术方式，但存在创伤大，恢复时间长，术后出现腰椎不稳等并发症，术后常因腰椎不稳、疤痕粘连等再次出现腰痛或坐骨神经痛。随着临床医学水平的提高和工业技术的进步，传统手术方式向微创化和腔镜化发展，现在以椎间盘镜为代表的脊柱微创器械越来越完善，镜下的微创术在保证疗效的前提下，大大的减少了患者的痛苦，缩短了围手术期的时间[1]。为了更好地开展对LDH的临床治疗工作，我们将椎间盘镜手术
(MED)与开放椎板开窗术(OD)进行疗效对比，现将结果报告如下。
1 资料与方法
11 临床资料 将2006年1月至2009年12月在我院治疗的LDH患者分为椎间盘镜手术组(MED组)与开放椎板开窗手术组(OD组)。根据配对条件(年龄相差不超过5岁，突出节段、突出形式相同，VAS评分相近)按照1：1配对研究,有效配对数为48对。有效配对的MED组48例，男31例，女17例，平均465岁。OD组48例，男29例，女19例，平均448岁，突出节段及突出类型两组例数相同： L3~L4 3例 ......
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