腰椎间盘突出症的微创治疗

目的　比较改良式经皮穿刺腰椎间盘摘除术 (APLD)和后中路椎间盘镜手术系统 (MED)椎间盘镜手术治疗腰椎间盘突出症的临床疗效。方法　回顾分析 1997年 12月～ 2 0 0 2年 12月采用APLD治疗腰椎间盘突出症 6 5 5例(75 0个间隙 )和 1999年 2月～ 2 0 0 3年 12月应用第二代MED椎间盘镜治疗腰椎间盘突出症 5 6 3例 (6 34个间隙 )的疗效及并发症。结果　所有病例均获得随访 ,APLD手术组随访时间 6～ 5 4个月 ,平均 2 4 .6个月 ,疗效优 2 6 3例 ,良30 5例 ,差 87例 ,优良率 86 .7% ;MED手术组随访 6～ 6 4个月 ,平均 2 8.6个月 ,疗效优 311例 ,良 2 18例 ,差 34例 ,优良率 94 .0 %。结论　APLD和MED椎间盘镜手术均是治疗腰椎间盘突出症的有效、安全可靠的微创技术 ,而MED技术总体上优于APLD技术。选择合适的适应证和仔细的操作是手术成功的关键

Mini-invasive technique in treatment of lumbar disc herniation

Objective To compare the clinical outcomes between the ameliorative percutaneous lumbar discectomy(APLD) and the second generation of micro endoscopic discectomy (MED) in the treatment of lumbar disc herniation.Methods 655 cases (750 discs) of lumbar disc herniation were operated with APLD from December 1997 to December 2002, and 563 cases (634 discs) of lumbar disc herniation were operated with MED from February 1997 to December 2002. The therapeutic effects and complications of surgical procedures were studied retrospectively.Results All the cases were followed up. The APLD group was followed up on an average 24.6 months (ranging from 6 to 54 months) with the results of excellent in 263 cases, good in 305 cases, and fail in 87 cases. The rate of excellent and good was 86.7%. The MED group was followed up on an average 28.6 months (ranging from 6 to 64 months) with the results of excellent in 311 cases, good in 218 cases, and fail in 34 cases. The rate of excellent and good was 94.0%.Conclusions Both APLD and MED are the effective, safety and mini-invasive techniques for the treatment of lumbar disc herniation, however,MED is better than APLD. The suitable indication and precise surgical technique are the key points for APLD and MED.