MED与有限化手术急诊治疗重症腰椎间盘突出症的疗效比较

【目的】比较显微内窥镜下椎间盘切除术（microendoscopic disceotomy，MED）与有限化手术（limited-incision LIM）急诊治疗重症腰椎间盘突出症的手术疗效。【方法】采用MED急诊治疗重症腰椎间盘突出症40例，冷光源下椎板拉钩法的小切口有限化手术（LIM）急诊治疗重症腰椎间盘突出症38例，将两者的手术疗效进行统计学分析。【结果】MED组比LIM组出血量少，手术时间长，有显著性差异，术后恢复正常工作／生活时间两组无显著性差异。按照Nakai疗效评定标准，MED组：优22例，良16例；LIM组：优21例，良14例；两组优良率MED组优于LIM组，但无显著性差异。【结论】MED比LIM急诊治疗重症腰椎间盘突出症疗效略好，出血少，更具有微创优势，但操作困难，时间略长，两者可根据具体情况选用。

Comparison Between MED and Limited-incision Method for Emergency Treatment of Severe Lumber Disc Herniation

Objective] To compare the emergency operative results of microendoscopic disceotomy （ MED） with limited-incision （LIM） method for severe lumber disc herniation. Methods] Forty cases of severe lumber disc herniation were operated with MED and 38 cases of severe lumber disc herniation were operated with limited-incision method by using laminectomy retractor under cold light source. The operative results of two groups were compared. Results] MED had less bleeding and a little more operation time than（LIM）, and there was significant difference between them. There was no significant difference in recovery time back to normal life between two groups. According to Nakai＇s postoperative evaluation criterion, the operative result of MED was evaluated as excellent in 22 cases and good in 16 cases. The operative result of （LIM）was evaluated as excellent in 21 cases and good in 14 cases. The excellent and good rate of MED group was a little better than that of LIM method group, but there was no significant difference between two groups. Conclusion]The result of MED is a little better than that of LIM method for severe lumber disc herniation, and has less bleeding and more superiority of minimal invasion. But MED is more difficult to be conducted and has more operative time. The choice of two methods should be based on each detail.