显微镜下手术治疗腰椎间盘突出症的临床观察

目的观察在手术显微镜下完成腰椎间盘突出髓核摘除术的疗效。方法分别选取30例住院行显微镜椎间盘切除术(microsurgical lumbar discectomy,MSLD)和传统手术(open lumbar discectomy,OLD)治疗单节段腰椎间盘突出症的患者,比较2种手术的切口长度、手术时间、出血量、住院天数,手术后JOA、VAS和ODI改善率情况。结果 MSLD组及OLD组的切口长度分别为(2.8±0.8)cm和(5.5±1.8)cm,手术时间分别为(57.0±16.9)min和(72.0±30.5)min,出血量分别为(85.0±33.0)mL和(110.0±48.0)mL,住院天数分别为(10.2±2.5)d和(12.2±3.6)d,2组间差异有统计学意义(P<0.01)。术后3个月随访时,MSLD组及OLD组的JOA改善率分别为85.3%±8.3%和84.9%±7.6%,VAS改善率分别为86.4%±1.9%和84.4%±2.1%,ODI改善率分别为81.5%±6.3%和80.8%±5.6%,两组间比较差异无统计学意义(P>0.05)。结论手术显微镜下完成腰椎间盘突出髓核摘除术切口小,术中出血量少,视野清晰,可减少对神经根及硬膜囊的手术刺激,安全、可靠性好,但熟练操作需要较长时间的显微外科训练基础。

Clinical effects of minimally invasive microscopic surgery on lumbar disc herniation

Objective To evaluate the efficiency of surgical treatment of lumbar disc herniation by microsurgical lumbar discectomy (MSLD). Methods A clinical review was conducted on the two surgical methods for single segment lumbar disc herniation (LDH) from April 2007 to June 2010, one group of 30 patients who underwent microsurgical lumbar discectomy (MSLD) and the other of 30 patients who underwent open lumbar discectomy (OLD). The factors considered included the length of skin incision, the operative time, volume of intraoperative bleeding, duration of hospitalization, pre- and postoperative assessment based on the criteria of Japanese Orthopaedic Association (JOA) Scores, visual analog scale (VAS), and the Oswestry disability index (ODI). Results The mean length of skin incision was (2.8±0.8)cm and (5.5±1.8)cm, the operative time was (57.0±16.9) min and (72.0±30.5) min, the blood loss was (85.0±33.0) mL and (110.0±48.0) mL, the hospitalization time was (10.2±2.5) days and (12.2±3.6) days for MSLD and OLD respectively. All had significant difference (P<0.01). Three months after the operation, the improvement rate of JOA was 85.3%±8.3％ and 84.9%±7.6％ for MSLD and OLD respectively. The improvement rate of VAS score was 86.4%±1.9％.and 84.4%±2.1％ for MSLD and OLD respectively. The improvement rate of ODI score was 81.5%±6.3％ and 80.8%±5.6％ for MSLD and OLD respectively. None showed any significant difference (P>0.05). Conclusion MSLD has advantages of little cut, little bleeding, clear surgery field, safety, little hurt to nerve root and dura mater. But skilled operation requires a relatively long period of microsurgery training as foundation.