后路椎间盘镜与显微镜下手术治疗腰椎间盘突出症中期疗效分析

目的：探讨后路椎间盘镜腰椎间盘切除术（MED）与显微镜下腰椎间盘切除术（MSLD）治疗腰椎间盘突出症（LDH）的中期临床疗效。方法将2009年3月至2010年4月于兰州大学第二医院骨科接受手术治疗的98例单节段LDH患者随机分为两组，其中接受MED治疗的患者44例（MED组），接受MSLD治疗的患者54例（MSLD组）。采用视觉疼痛模拟评分（VAS）、JOA评分和Oswestry功能障碍指数（ODI）评价两组患者手术疗效。结果MED组创伤小、出血少，术后恢复快。两组患者手术切口长度、出血量、恢复工作时间比较，均差异有统计学意义（P＜0．01）；手术时间、住院时间、并发症发生率比较，差异无统计学意义（P＞0．05）。MED组和MSLD组患者术后平均随访时间为49．13个月和47．24个月，末次随访时两组患者术后腰腿痛VAS评分、JOA评分、ODI指数较术前均明显改善（P＜0．01），组间比较差异无统计学意义（P＞0．05）。结论MED与MSLD均是治疗单节段LDH的有效方法，但MED创伤小、术后患者可早期下地活动，是理想的微创手术。

Comparison of mid-term effects between microendoscopic discectomy and microsurgical lumbar discectomy for operatively treating lumbar disc herniation

Objective To evaluate the mid‐term efficacy of microendoscopic discectomy (MED) and microsurgical lumbar discectomy (MSLD) for treating lumbar disc herniation (LDH) .Methods 98 patients with single segment LDH in the Orthopedic department of the Second Hospital of Lanzhou University from March 2009 to April 2010 were divided into 2 groups ,including 44 cases undergoing MED and 54 cases undergoing MSLD .The operative efficacies were assessed by the visual analogue scale (VAS) , Japanese Orthopedic Association (JOA) scores and Oswestry Disability Index (ODI) .Results There were statistically significant differences in the skin incision length ,amount of intraoperative blood loss and time of returning to work between the two groups (P<0 .01) ,while the operation time ,average hospital stay time and incidence of complications showed no statistically significant differences (P>0 .05) .The mean follow‐up duration was 49 .13 months in the MED group and 47 .24 months in the MSLD group respectively .At the last follow‐up the postoperative back and leg pain VAS scores ,JOA scores and ODI in each group were signifi‐cantly improved compared with the preoperative data (P<0 .01) .However ,there were no statistically significant differences in the intergroup comparison .Conclusion MED and MSLD are the effective methods for treating single segment LDH .However ,MED has less trauma and early out‐of‐bed ambulation ,is an ideal minimally invasive surgery .