经皮腰椎间盘切割术与显微内镜腰椎间盘摘除术的远期随访分析

目的 回顾性分析经皮腰椎间盘切割术(PLD)与显微内镜腰椎间盘摘除术(MED)治疗腰椎间盘突出症的远期疗效与生活质量,探讨每种术式的临床应用优势.方法 采用查阅原始病案、信函与电话相结合的随访方式,对2000年1月至2002年3月间来东南大学附属中大医院接受PLD治疗的患者共104例及MED治疗的患者82例进行远期随访研究,随访的内容包括Oswestry功能障碍指数(ODI)、JOA腰痛疗效评定标准(JOA)、SF-36量表(SF-36)的评分,使用配对t检验χ2检验及Fisher精确概率法等方法进行统计学分析.结果 PLD组和MED组评价随访时间分别为5.2～7.3(6.6±0.7)年和5.3～7.2(6.4±0.5)年.MED组的远期ODI、SF-36评分要好于PLD组(秩和检验,P值分别为0.0397和0.0582),JOA信函问卷评分组间差异无统计学意义(秩和检验,P值为0.9742);而MED组的住院时间、住院费用则明显长于或多于后者(方差分析,均P<0.01);远期并发症发生率分别为MED组3.49%,PLD组未出现手术相关并发症.结论 MED或PLD治疗腰椎间盘突出症均具有创伤小、恢复快、疗效好且稳定的特点.MED的临床远期疗效高于PLD,但是其并发症稍高,住院时间和费用也有所提高.

Long-term outcomes of percutaneous lumbar discectomy and microendoscopic discectomy for lumbar disc herniation

Objective To evaluate the long-term effects of percutaneous lumbar discectomy(PLD) and microendoscopic discectomy(MED) in treatment of lumbar disc herniation. Methods A questionnaire survey by letter and telephone was conducted among 104 patients undergoing PLD and 82 patients undergoing MED during January 2000 to March 2002, to investigate the Oswestry disability index (ODI), Short Form-36 (SF-36) score, and Japanese Orthopedic Association (JOA) score. Results The excellent/good rate (ODI score=0-20%) of the MED group was 79.27%, significantly higher than that of the PLD group (71.15%, P=0.0397). However, longer The hospitalization duration of the MED group was 11,6 d, significantly longer than that of the PLD group (7.9 d, P<0.01), and the mean cost of the MED group was, significantly higher than that of the PLD group (P<0.01). Long-term complications were observed in 3 patients of the MED group (3.49%) while none in the PLD group. Conclusion Both PLD and MED are minimally-invasive-technique with a long-term efficacy and safety on lumbar disc herniation. Although the long-term outcome of the MED group is better than PLD, the complication rate, hospitalization duration, and cost of the MED group are higher.