改良直视下小切口微创手术与椎间盘镜及传统手术治疗腰椎间盘突出症的疗效比较

背景：近年来微创手术用于的腰椎间盘突出症手术治疗已得到了较广泛的发展，但目前采用的多数微创手术方法由于其设备昂贵、学习周期长，基层医院难以开展。本研究采用改良的直视下小切口微创髓核摘除术，为单纯腰椎间盘突出症的患者提供了新的治疗方法。目的：比较改良的直视下小切口微创手术、椎间盘镜下及传统椎板切除手术治疗腰椎间盘突出的临床效果。方法：回顾分析我院2002年1月至2010年7月收治的单节段腰椎间盘突出症患者143例，分为3组，分别接受改良的直视下小切口微创髓核摘除术（47例）、椎间盘镜下髓核摘除术（44例）及传统椎板切除髓核摘除术（52例），并对各组的治疗情况和近期疗效进行比较研究。结果：平均随访时间为：直视下小切口微创手术组425d，椎间盘镜手术组533d，传统手术组797d，采用日本骨科学会（JOA）关于下腰痛的评分标准进行疗效评定，3组患者治疗后优良率分别为：97．9％、95．5％、96．2％，治疗后平均改善率分别为：92．2％、87．6％、90．1％，组间比较无显著性差异（P〉0．05），但在切口长度、术中出血量、术后卧床时间等方面，直视下小切口微创手术较传统手术显现了明显的优势，手术时间也较椎间盘镜组明显缩短，其差异有统计学意义（P〈0．05）。结论：改良的直视下小切口髓核摘除术治疗腰椎间盘突出症的疗效肯定，创伤小，对脊柱正常结构的破坏轻微，患者恢复快，满意度高，而且学习曲线短、无需借助专用通道及光源等特殊手术器械，是一种值得推广的术式。

Comparison of result of modified microtrauma windowed diskectomy,microendoscopic diskectomy and traditional diskectomy in the treatment of lumbar disc herniation

Background:In recent years,minimally invasive surgery for lumbar disc herniation has been widely developed.But the majority of minimally invasive surgical methods is difficult to carry out in the primary hospital due to its expensive equipment and long learning curve.In this study,we adopted modified microtrauma windowed diskectomy under direct vision,provide a new treatment method for the simple lumbar disc herniation patients. Objective:The present study is to compare the short-term curative effect of microtrauma windowed diskectomy,microendoscopic diskectomy and traditional diskectomy in the treatment of lumbar disc herniation. Methods:A total of 143 patients with monosegment lumbar disc herniation from January 2002 to July 2010 were divided into three groups.The patient of different groups under-went microtrauma windowed diskectomy(47 cases),microendoscopic diskectomy (44 cases)and traditional diskectomy(52 cases)respectively,and the clinical data of different groups were analyzed. Results:The average follow-up time is 425 days(microtrauma group),533 days(microendoscopic group)and 797 days (traditional group).The scoring system of Japanese Orthopaedic Association(JOA)were applied to evaluate their curative effect. The rate of excellent and good of three groups was 97.9%,95.6%and 96.2%respectively and the mean postoperative improvement rate was 92.2%,87.6%and 90.1%respectively.There was no significant difference between the curative effects of the three methods.But there was a significant difference between the microtrauma group and the traditional group in blood loss,length of incision,the time lying in bed after operation.The microtrauma windowed diskectomy was significantly better than traditional diskectomy,and the average operating time of microtrauma group was significantly shorter than microendoscopic group. Conclusions:The microtrauma windowed diskectomy is a safe and effective treatment of lumbar disc herniation,and the technique has the advantage of less trauma and damage to spinal structure.Patients get faster recovery.It is one of the better method for the treatment of lumbar disc herniation.