[1]马志锋* 贺宪 陈炳泉.微创通道髓核摘除术治疗腰椎间盘突出症[J].中国微创外科杂志,2020,01(9):802-806.
　Ma Zhifeng,He Xian,Chen Bingquan..Minimally Invasive Approach Discectomy for Lumbar Disc Herniation[J].Chinese Journal of Minimally Invasive Surgery,2020,01(9):802-806.
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微创通道髓核摘除术治疗腰椎间盘突出症()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2020年9期
页码:
802-806
栏目:
临床研究
出版日期:
2020-09-25

文章信息/Info

Title:
Minimally Invasive Approach Discectomy for Lumbar Disc Herniation
作者:
马志锋* 贺宪 陈炳泉
（广州市番禺区中医院骨二科，广州511400）
Author(s):
Ma Zhifeng;  He Xian;  Chen Bingquan.
Department of Orthopaedics, Panyu Traditional Chinese Medicine Hospital, Guangzhou 511400, China
关键词:
腰椎间盘突出症; 微创通道髓核摘除术
Keywords:
Lumbar disc herniation; Minimally invasive approach discectomy
文献标志码:
A
摘要:
目的探讨微创通道髓核摘除术治疗腰椎间盘突出症的效果。方法回顾性分析2015年6月~2017年3月我院38例微创通道髓核摘除术及35例传统半椎板切除髓核摘除术资料，根据患者意愿选择治疗方法。比较2组手术指标，术前及术后1天、1个月、5个月、10个月进行腰痛视觉模拟评分（Visual Analogue Scale，VAS）、Oswestry功能障碍指数（Oswestry Disability Index，ODI）、日本骨科协会(Japanese Orthopedic Association，JOA)评分，用改良MacNab标准评估疗效。结果微创组手术时间、术中出血量、下床活动时间、术后住院时间均显著优于传统组［（45.0±6.3）min vs. （82.5±20.2）min，t=-10.547，P=0.000；（23.1±5.7）ml vs. （57.6±13.4）ml，t=-14.143，P=0.000；（2.8±0.8）d vs. （5.4±1.1）d，t=-11.197，P=0.000；（6.4±1.6）d vs. （15.3±2.4）d，t=-19.187，P=0.000］，微创组并发症发生率低于传统组，但差异无显著性（P>0.05)。2组术前VAS、ODI、JOA评分差异均无显著性（P>0.05）；2组术后各时点VAS、ODI、JOA评分均显著优于术前（P<0.05），且微创组优于传统组（P<0.05）。术后10个月采用改良MacNab标准评价，微创组优、良、可、差分别为24、13、1、0例，传统组为16、12、7、0例，微创组优良率（97.4%，37/38）明显高于传统组（80.0%，28/35）（χ2=3993，P=0.046）。结论与传统半椎板切除髓核摘除术相比，微创通道髓核摘除术治疗腰椎间盘突出创伤小，恢复快，有助于神经功能恢复，临床疗效较好。
Abstract:
ObjectiveTo investigate the clinical effect of discectomy by minimally invasive approach for lumbar disc herniation.MethodsA retrospective analysis selected information of 38 patients who were treated with discectomy by minimally invasive approach and 35 patients who were treated with discectomy by traditional hemilaminectomy from June 2015 to March 2017. The treatment method was selected according to the patient’s wishes. Surgical index was compared between the two groups. The pain Visual Analogue Score (VAS), Oswestry Dysfunction Index (ODI), and Japanese Orthopedic Association (OA) scores were compared in the two groups before and after surgery at 1 day, 1 month, 5 months and 10 months. The efficacy was evaluated by using modified MacNab criteria.ResultsThe operation time, intraoperative bleeding volume, time of getting out of bed and hospital stay in the minimally invasive group were significantly better than those in the traditional group ［(45.0±6.3) min vs. (82.5±20.2) min, t=-10.547, P=0.000; (23.1±5.7) ml vs. (57.6±13.4) ml, t=-14.143, P=0.000; (2.8±0.8) d vs. (5.4±11) d, t=-11.197, P=0.000; (6.4±1.6) d vs. (15.3±2.4) d, t=-19.187, P=0.000］. The incidence of complications in the minimally invasive group was less than that in the traditional group but no statistical difference was found (P>0.05). There were no significant differences in preoperative VAS, ODI, and JOA scores between the two groups (P>0.05). The VAS, ODI, and JOA scores of each time point after operation in the two groups were significantly better than those before operation (P<0.05), and scores of the minimally invasive group were better than the traditional group (P<0.05). The modified MacNab criteria was used at 10 months after operation. the excellent, good, acceptable and poor results in the minimally invasive group were 24 cases, 13 cases, 1 case, and 0 case, and in the traditional group were 16 cases, 12 cases, 7 cases, and 0 case, respectively. The excellent and good rate of minimally invasive group (97.4%, 37/38) was significantly higher than that of traditional group (80.0%, 28/35; χ2=3.993, P=0.046).ConclusionCompared with discectomy by traditional hemilaminectomy, discectomy by minimally invasive approach in the treatment of lumbar disc herniation patients has advantages of less intraoperative trauma, more rapid recovery, more helpful to restore nerve function, and better clinical efficacy.

参考文献/References:

[1]Ugurlu M,Aksekili MAE,Alkan BM,et al.Effects of artcure diffusional patch application on pain and functional status in lumbar disc herniation patients:a prospective randomized controlled study.Turk J Med Sci,2017,47(3):874-882.
[2]张栋,王艺苑,鲁齐林,等.选择性神经根阻滞联合椎间孔镜治疗老年退行性腰椎管狭窄症的疗效观察.中国骨与关节损伤杂志,2017,32(11):1189-1190.
[3]Aizawa T,Ozawa H,Kusakabe T,et al.Reoperation for recurrent lumbar disc herniation: a study over a 20year period in a Japanese population.J Orthop Sci,2012,17(2):107-113.
[4]康鹏程，杨静海，陈良龙.钙化型腰椎间盘突出症及其经皮内镜治疗进展.中国微创外科杂志,2020,20(5):463-466,470.
[5]Kang Q,Li X,Cheng Z,et al.Effects of release and decompression techniques on nerve roots through percutaneous transforaminal endoscopic discectomy on patients with central lumbar disc herniation.Exp Ther Med,2017,13(6):2927-2933.
[6]康辉,蔡贤华,徐峰,等.Quadrant通道下经椎间孔腰椎椎体间融合术治疗复发性腰椎间盘突出症的疗效.中国脊柱脊髓杂志,2013,23(3):198-203.
[7]周思启,杨世龙,王立飞,等.经皮内镜椎间孔入路椎间盘髓核摘除术治疗腰椎间盘突出症的效果.颈腰痛杂志,2017,38(6):549-551.
[8]王种,田征,梁青福,等.经皮椎间孔镜TESSYS技术治疗单节段腰椎间盘突出症60例分析.中国内镜杂志,2016,22(1):32-36.
[9]张之栋,杜怡斌,储建军.经皮椎间孔镜腰椎间盘摘除术与微创经椎间孔腰椎融合术治疗腰椎间盘突出症的前瞻性随机对照研究.中国微创外科杂志,2015,15(7):583-587.
[10]艾龙.微创通道下精确开窗与传统开放手术行单纯髓核摘除术治疗腰椎间盘突出症的疗效对比.颈腰痛杂志,2018,39(4):492-493.
[11]Wong KW,Ho CH,Yu TC,et al.Clinical outcome of minimally invasive decompression without discectomy in contained foraminal disc herniation:a singlecenter study.World Neurosurg,2018,118(4):e367-e374.

备注/Memo

备注/Memo:
*通讯作者，Email：mzf65232@163.com
更新日期/Last Update: 2020-12-09