摘要
目的:比较内窥镜手术与开放手术治疗复发性腰椎间盘突出症(RLDH)的临床效果及优缺点。方法:对2008年8月至2010年12月手术治疗的35例复发性腰椎间盘突出症患者进行回顾性研究。按手术方式分为两组,内窥镜组14例,行椎间盘镜(MED)下经椎间孔减压椎间融合(TLIF);开放手术组21例,行后路全椎板减压椎间融合(PLIF)。两组患者均同时采用了椎弓根螺钉内固定。分别比较两组患者的手术时间、出血量、术后引流量、镇痛药剂量、术后卧床时间。采用视觉模拟疼痛评分(VAS)、JOA评分(15分法)和汉化版Oswestry下腰痛功能障碍指数(CODI)对患者术前、术后及末次随访时的临床症状体征以及功能状态进行评价,对结果进行统计分析。结果:两组患者手术时间无差异(P>0.05),内窥镜组术中出血量、术后引流量、术后所需镇痛药剂量和卧床时间以及术后腰痛VAS评分均明显少于开放手术组(P<0.01)。35例患者均获1年随访,两组患者术前术后JOA评分比较差异无统计学意义(P>0.05),内窥镜组CODI指数优于开放手术组(P<0.05)。结论:两种术式均能获得满意的临床效果;椎间盘镜下TLIF手术创伤小、术后疼痛少、功能恢复较好,是目前治疗RLDH的首选方法。
Objective ：To compare the clinical effect, advantages and disadvantages of endoscopic surgery and open surgery in treating the recurrent lumbar disc herniation. Methods：From August 2008 to December 2010 ,the data of 35 pa- tients with recurrent lumbar disc herniation were retrospectively analyzed. The patients were divided into endoscopic surgery group and open surgery group according to operative methods. Fourteen patients in endoscopic surgery group were treated with the transforaminal lumbar interbody fusion by micro-endoscopic discectomy （MED） and the other 21 patients in open surgery group were treated with posterior lumbar interbody fusion by open surgery. All patients were fixed by vertebral pedicle screw. The operation time, volume of bleeding and drainage after operation, analgesic dosage and time in bed after operation were ob- served. Visual Analogue Scale （VAS）, Japanese Orthopedic Association （JOA） and Chinese Oswestry Disability Index （CODI） were used to evaluate the clinical effects before and after operation. Results ：There was no significant difference in operation time between two groups （P〉0.05）. Volume of bleeding and drainage after operation, analgesic dosage and time in bed after op- eration ,VAS score in endoscopic surgery group was less than that of open surgery group （P〈0.01）. All patients were followed up for 1 year. There was no significant difference in JOA between two groups （P〉0.05）. CODI in endoscopic surgery group was better than that of open surgery group （P〈0.01）. Conclusion： Both operative methods can obtain good clinical effects, but the transforaminal lumbar interbody fusion operation by micro-endoscopic discectomy （MED） has advantage of less traumatic and less pain, better functional recovery, it is a first choice in treating the recurrent lumbar disc herniation.
出处
《中国骨伤》
CAS
2013年第10期810-814,共5页
China Journal of Orthopaedics and Traumatology
关键词
椎间盘移位
复发
脊柱融合术
内窥镜
外科手术
微创性
Intervertebral disk displacement
Recurrence
Spinal fusion
Endoscopes
Surgical procedures, minimally invasive
作者简介
通讯作者：梁冬波E-mail：nick201@126．com
