显微内镜腰椎间盘髓核摘除术治疗 腰椎间盘突出症的疗效研究

The efficacy of endomicroscopy lumbar discectomy and fenestration discectomy for 122 cases of patients with lumbar disc herniation

摘要:

目的 观察显微内镜腰椎间盘髓核摘除术和开窗减压髓核摘除术在腰椎间盘突出症治疗中的应用价值。方法 选择2008年12月~2013年12月于该院收治的确诊为腰椎间盘突出症患者共122例，根据治疗方法不同分为内镜组和开窗组。内镜组给予显微内镜腰椎间盘髓核摘除术，开窗组给予开窗减压髓核摘除术，两组患者术后均给予抗炎抗感染等治疗。术后随访3个月，比较两组的治疗效果。结果 内镜组的治疗效果53例为优，3例为良，治疗优良率为91.80%，开窗组的治疗效果44例为优，5例为良，治疗优良率为80.33%，内镜组的治疗效果明显优于开窗组（χ2=9.304，P <0.05）。内镜组患者的平均术中出血量明显少于开窗组（t =34.781，P <0.05），且内镜组患者的平均术中时间、卧床时间以及总住院时间均明显少于开窗组（t =16.934，41.719，6.076，均P <0.05）；两组患者术中或术后并发症的发生情况如脑脊液漏、神经根损伤以及术后腰痛等无显著性（χ2=0.052，0.000，0.105，均P >0.05）。两组患者的平均髓核质量无显著性（t =0.382，P <0.05）。结论 采用显微内镜腰椎间盘髓核摘除术治疗腰椎间盘突出症效果优于开窗减压髓核摘除术，安全性较好，值得临床推广。

Abstract:

【Objective】 To observe the value of endomicroscopy lumbar discectomy and fenestration discectomy applied in patients with lumbar disc herniation. 【Methods】 122 cases of patients diagnosed as lumbar disc herniation treated in our hospital from December 2008 to 2013 were selected and divided into endoscopic group and fenestration group by different treatments. Endomicroscopy lumbar discectomy was given in endoscopic group, while fenestration discectomy given in fenestration group. Anti-inflammatory and anti-infective therapy were given in both of the two groups. All the patients were followed up more than 3 months and the effect of treatment was compared. 【Results】 53 cases in endoscopic group were excellent, 3 were good, and the excellent and good rate of treatment was 91.80%. 44 cases in fenestration group were excellent, 5 were good, and the excellent and good rate of treatment was 80.33%. The effect in endoscopic group was better than that in fenestration group (χ2=9.304, P<0.05). The average blood loss in endoscopic group was less than that in fenestration group (t=34.781, P<0.05), and the average surgery time, bed time and total length of hospital stay in endoscopic group were less than those in fenestration group(t=16.934, 41.719, 6.076, all P<0.05). There were no differences of postoperative complications such as cerebrospinal fluid leakage, nerve root injury and postoperative lumbago (χ2=0.052, 0.000, 0.105, all P>0.05). There was no statistical difference of nucleus weight in the two groups (t=0.382, P<0.05). 【Conclusion】 The endomicroscopy lumbar discectomy was better and safer than fenestration discectomy. It was worth using in the clinical practice.