腰椎间盘镜髓核摘除术的中远期疗效分析

目的：评价腰椎间盘镜髓核摘除术的中、远期疗效。方法：回顾分析109例采用腰椎间盘镜髓核摘除术治疗的腰椎间盘突出症患者，男61例，女48例；年龄25-68岁，平均37．7岁。病变部位：k3.45例，k4.542例，L5S149例，L4.5和L5S113例。手术：单侧1个节段88例；同侧2个节段13例，1个节段双侧8例。评估术后1年和平均5-2年的疗效及满意度，并对影像学资料完整的患者手术前后椎间隙高度和稳定性进行对比。结果：术后1年和平均5.2年JOA评分由术前平均（6．40±1．68）分，分别提高到（13．40±1．42）分和（13．15±1．35）分（P〈0．01）；VAS评分由术前平均（7．10±1．55）分分别下降至（1．90±0．84）分和（2．10±0．58）分（P〈0．01）。术后1年优77例，良23例，可9例，差0例；术后平均5．2年优75例，良23例，可11例，差0例。患者自我评价满意度分别为95．4％和94．5％，平均恢复工作时间1个月。影像学显示无一例发生腰椎失稳征象，手术椎间隙高度丢失在术后1年和平均5．2年的发生率分剐为57．8％（26／45）和93．3％（42／45）。结论：腰椎间盘镜髓核摘除术中、远期疗效较好，是治疗腰椎间盘突出症的可靠方法。微创手术仍不能有效避免手术椎间隙高度的丢失，但并不一定导致椎间不稳和神经根受压。

Analysis of intermediate and long term clinical effects on discectomy with diskoscope

Objective: To estimate intermediate and long term clinical effects of lumbar intervertebral disc herniation on discectomy with diskoscope. Methods: A hundred and nine patients with lumbar intervertebral disc herniation were retrospectively analyzed. The patietnts were operated with diskoscope. There were 61 males and 48 females. The age was from 25 to 68 years old with an average of 37.7 years. The affected region of patients were L_3,4(5 cases),L_4,5(42 cases),L₅S₁(49 cases),L_4,5 and L₅S₁(13 cases). Among them,88 cases with single side and one segment,13 cases with homolateral and two segments,8 c- ases with hibateral and one segment were operated. The curative effects were followed up and estimated by recording satisfaction degrees at 1 year and 5.2 years(average) after operation. Moreover,intervertebral space height and the spinal stability of t- he patients were compared by imaging data before and after operation.Results: At 1 year and 5.2 years(average) after operati- on,the scores by JOA standard were improved from 6.40±1.68 to 13.40±1.42,13.15±1.35(P<0.01) respectively;the scores by VAS standard were reduced from 7.10±1.55 to 1.90±0.84,2.10±0.58(P<0.01)respectively;the excellent and good rate was 91.7%(100/109) and 89.9%(98/109) respectively;the satisfaction degree of the patients was 95.4% and 94.5% respectively. The average time before working was 1 month. The imaging data of 45 patients were complete in the study,no lumbar instability sign were found. The loss rates of intervertebral space height were 57.8%(26/45),93.3%(42/45) respectively at 1 year and 5.2 y- ears(average) after operation. Conclusion: Discectomy with diskoscope has a good intermediate and long term clinical effects,it is a reliable method in the treatment of lumbar intervertebral disc herniation. It doesn't uncertainly cause instability of intervertebral space and root compression, though it can't avoid the loss of intervertebral space height.