腰椎椎体后缘离断症两种不同的手术方法疗效比较

Comparison of therapeutic effects of two different operative treatments for lumbar body posterior bony edges separation

摘要:

目的 探讨比较微创手术和开放手术治疗腰椎椎体后缘离断症的临床疗效。方法 回顾性分析在2009年10月-2012年4月分别采用显微椎间盘镜下精确减压法（微创组）和全或半椎板开窗（开放组）治疗腰椎椎椎体后缘离断患者31例。其中，微创组14例，开放组17例，分别比较两组手术时间、术中出血量、术后引流量、住院时间，以及术前、术后VAS评分、JOA评分和ODI评及优良率。结果 术后所有患者得到随访，随访时间12～28个月，平均（16.8±2.4）个月，微创组手术时间、术中出血量、术后引流量及住院时间均明显少于开放组，差异有显著性（P <0.05）。两组术后3个月、末次随访疼痛VAS评分、JOA评分和ODI评分与术前比较差异均有显著性（P <0.05），两组之间术后3个月、末次随访疼痛VAS评分、JOA评分和ODI评分差异无显著性（P <0.05）。末次随访时采用改良Macnab标准评价临床效果，开放组优良率为94.1％，微创组优良率为92.9％，临床疗效相当。结论 两组手术方法治疗腰椎椎体后缘离断症的治疗均能取得效果疗效，微创手术优势体现在早期，两种手术方式中期临床疗效相当。

Abstract:

【Objective】 To compare the therapeutic effects of microendoscopic discectomy and open surgery for lumbar body posterior bony edges separation. 【Methods】 31 cases of lumbar body posterior bony edges separation undergone surgical treatment from October 2009 to April 2012 were reviewed retrospectively. 14 of 31 operated accurately were reduced pressure by microendoscopic surgery (minimally invasive group), the other cases were operated open surgery (open group).The operation time, intraoperative blood loss, seroma volume of drainage after surgery, length of hospital stay, and preoperative and postoperative VAS score, JOA score, ODI evaluation, were evaluated during the follow-up. 【Results】 All patients were followed up for 12 to 28 months, average (16.8±2.4) months. The operation time, intraoperative blood loss, seroma volume of drainage after surgery and length of hospital stay in minimally invasive group were significantly less than the open group (P <0.05). The postoperation 3 months, the last follow-up pain VAS scores, JOA score, ODI score in two groups were compared with preoperative with significant difference (P <0.05), postoperative 3 months, the last follow-up pain VAS score, JOA score, there was no statistically significant difference of ODI score between the two groups (P <0.05). At the time of the last follow-up modified Macnab criteria was used to evaluate the clinical effect, the open group was 94.1%, the minimally invasive group was 92.9%. 【Conclusion】 Microendoscopic and open surgery treatment of treatment for lumbar body posterior bony edges separation can obtain satisfactory therapeutic effects, minimally invasive surgery advantage in the early days, there was no difference in the mid-term therapeutic effects.