MED与椎板开窗治疗腰椎间盘突出症的临床比较

目的：比较显微内镜腰椎间盘髓核摘除术（MED）和开窗减压髓核摘除术,评价MED的临床价值。方法：对261例腰椎间盘突出症手术患者进行回顾性比较研究。124例接受MED,男72例,女52例,平均年龄37.6岁（26～63岁）,病变节段：L4,566例,L5S158例。同期137例经开窗减压髓核摘除术,男66例,女71例,平均年龄44.5岁（25～71岁）,病变节段：L4,564例,L5S173例。MED采用旁正中小切口,在内镜下完成神经根探查、减压和椎间盘髓核摘除。开窗减压髓核摘除术采用经椎板间隙开窗、神经根减压和椎间盘髓核摘除。结果：MED组平均随访14.5个月,单节段手术时间（85±15）min,失血（50±10）ml,术后卧床（50±8）h。开放手术组平均随访15.5个月,手术时间（60±15）min,失血（80±20）ml,术后卧床（150±24）h。MED组手术后切口疼痛轻,镇痛治疗显著少于开放手术组。采用改良Macnab标准评定随访结果：优94例,良25例,可5例。开放手术组症状改善情况与MED组相似。结论：同开窗减压髓核摘除术比较,MED表现相似的短期临床效果,但具有切口小、组织损伤轻和恢复较快的特点。

Clinical comparison between micro-endoscopic discectomy(MED)and open discectomy for treatment of lumbar disc herniation

Objective: To compare between micro-endoscopic discectomy (MED)and open decompression discectomy,and assess the clinical value of MED. Methods: Two hundreds and sixty-one cases who suffered from lumbar disc herniation had a retrospective study. One hundred and twenty-one of 261 patients were treated with MED including 72 male and 52 female with an average age of 37.6 years ranging 26 to 63,the segment of herniated discs were at L_4,5 in 66 and at L₅S₁ in 58. The other 137 patients were treated with decompression by fenestration and discectomy including 66 male and 71 female with an average age of 44.5 years ranging 25 to 71,the segment of herniated discs were at L_4,5 in 64 and at L₅S₁ in 73. MED was performed via a small paracentral approach to have thorough root exploration,direct decompression and remove nucleus gelations by endoscopes. Open decompression discectomy was performed decompression by fenestration and discectomy. Results: MED group were followed up for 14.5 months on average,the operative time was(85±15)minutes and blood loss was(50±10) ml,time of la- ying in bed after operation was(50±8) hours. Open decompression group were followed up for 15.5 months on average,operati- ve time was(60±15) minutes and blood loss was(80±20) ml,time of laying bed after operation was(150±24)hours. MED group needed significantly less narcotic medication after operation than open decompression group. According to modified Macnab criteria,the results were excellent in 94,good in 25,fair in 5 in MED group and excellent in 101,good in 28,fair in 8 in open decompression group. Conclusion: As compared with open decompression group,MED offers a similar short-term clinical outcome,but with smaller incision,less tissue trauma and quicker recovery.