后路椎间盘镜与椎板开窗减压治疗单节段LDH的疗效观察

发布时间：2018-05-13 18:54

本文选题：外科手术 + 微创性　；参考：《重庆医学》2017年18期

【摘要】：目的探讨后路椎间盘镜髓核摘除术(MED)与传统椎板开窗髓核摘除术(FD)治疗腰椎间盘突出症(LDH)的临床疗效。方法将2009年4月至2012年1月于该院接受手术治疗的168例单节段LDH患者按手术方式分为MED组(81例)和FD组(87例),比较两组患者手术相关指标。术后定期随访,采用视觉疼痛模拟评分(VAS)、JOA评分和Oswestry功能障碍指数(ODI)评价患者手术疗效。末次随访时通过测量患者腰椎曲度、椎间隙高度、椎间水平位移和角位移评估患者腰椎稳定性。结果 MED组患者切口长度、术中出血量、手术时间、住院时间均低于FD组(P0.05)。所有患者均完成4年以上随访,末次随访时两组患者各项评分较术前均明显改善(P0.05),组间比较差异均无统计学意义(P0.05)。两组患者椎间隙高度较术前均明显降低,FD组术后腰椎曲度较MED组明显减小,MED、FD组分别有1、3例患者出现腰椎失稳。结论 MED与FD治疗单节段LDH均可取得良好的临床疗效,MED手术时间短、创伤小、对腰椎稳定性影响小,是理想的微创手术。
[Abstract]:Objective to investigate the clinical effect of posterior endoscopic discectomy (MED) and traditional laminectomy (FDD) in the treatment of lumbar disc herniation (LDH). Methods from April 2009 to January 2012, 168 patients with single segment LDH were divided into MED group (n = 81) and FD group (n = 87). Visual pain analogue score (VAS) and Oswestry dysfunction index (ODI) were used to evaluate the outcome of the operation. Lumbar stability was evaluated by measuring lumbar curvature, intervertebral space height, intervertebral horizontal displacement and angular displacement at the last follow-up. Results the incision length, blood loss, operation time and hospital stay in MED group were lower than that in FD group (P 0.05). All the patients were followed up for more than 4 years. At the last follow-up, the scores of the two groups were significantly improved compared with those before operation (P 0.05), and there was no significant difference between the two groups (P 0.05). The height of intervertebral space in both groups was significantly lower than that before operation. The lumbar curvature of FD group was significantly lower than that of MED group. There were 13 cases of lumbar instability in MEDD-FD group. Conclusion both MED and FD in the treatment of single segment LDH have a good clinical effect. It is an ideal minimally invasive operation with short operation time, little trauma and little influence on the stability of lumbar vertebrae.
【作者单位】：兰州大学第二医院骨科;兰州大学第二医院骨科研究所;
【分类号】：R687.3

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