椎间盘镜与椎板开窗治疗单节段腰椎间盘突出症疗效对比分析_药学论文.docVIP

椎间盘镜与椎板开窗治疗单节段腰椎间盘突出症疗效对比分析_药学论文 椎间盘镜与椎板开窗治疗单节段腰椎间盘突出症疗效对比分析_药学论文 【摘要】 比较椎间盘镜下髓核摘除术和椎板开窗髓核摘除术治疗单节段单侧腰椎间盘出症的临床效果及优缺点。［方法］回顾性分析2003年7月～2005年7月手术治疗的单节段椎间盘突出症患者69例，其中应用椎间盘镜手术治疗腰椎间盘突出症患者32例、椎板开窗手术37例。分别比较手术时间、术中出血量、术后卧床时间、术后出院时间、术前术后JOA评分、腰痛及腿痛VAS评分。［结果］椎间盘镜组和椎板开窗组疗效优良率分别为优良率93％和91％，无显著性差异，同时两组患者术后腿痛缓解无显著性差异；而两组患者在术后腰痛VAS评分、术中出血量、术后卧床时间及术后住院时间有显著性差异，椎间盘镜组要明显优于常规椎板开窗组。［结论］两种术式都能有效缓解腰椎间盘突出症患者的症状，但MED手术创伤小、出血少、术后早期康复快，术后遗留腰痛较轻。 【关键词】 腰椎 椎间盘突出 椎板开窗 内窥镜 Abstract ［Objective］To compare the clinical results，advantages and disadvantages of the monosegment lateral lumbar disc herniated patients with the treatment of microendoscopic discectomy(MED) and fenestration discectomy(FD)．［Methods］Sixty-nine cases operated with mono，among them，32 cases operated with microendoscopic discectomy and 37 cases operated with fenestration discectomy．The operating time，blood loss,time stay，duration of hospitalization after operation were compared．［Results］The rate of excellent and good outcomes was 93％ in MED group,and 91％ in FD group．No significant difference was found between them，and the same with the postoperative sciatica relief significant differences ould be observed in the operation time，blood loss，duration of hospitalization after operation and postoperative visual analog scales．［Conclusion］The symptoms of the lumbar disc herniation can be reliefed effectively by both methods， but micro，less blood loss，earlier rehabilitation，less postoperative low back pain Key words：lumbar vertebrae;lumbar disc herniation;endoscopy;fenestration discectomy 椎板开窗髓核摘除术是治疗腰椎间盘突出症的标准术式，长期随访结果证明其取得了令人满意的结果〔1〕。近年来，随着现代微创技术的发展，椎间盘镜下腰椎间盘髓核摘除术(microendoscopic discectomy，MED)也得到了广泛的应用〔2，3〕。本科自2003年7月～2005年7月应用椎间盘镜治疗单节段腰椎间盘突出症32例，同期行椎板开窗髓核摘除术(fanestration discectomy，FD)37例，现将两组病例进行比较，评价两种术式的优缺点。 1临床资料 1一般资料 2003年7月～2005年7月手术治疗单节段单侧腰椎间盘突出症患者69例，所有患者(表1)均为单节段单侧腰椎间盘突出症，临床表现为腰痛伴单侧下肢疼痛，经系统保守治疗3个月无效。术前均行腰椎正侧位、过伸过屈位X线片检查，同时行腰椎CT和(或)MRI检查。结合临床、X线片、CT或MRI确定手术节段。表1一般资料 分组例数男女平均 年龄突出节段L3突出类型突出脱出游离突出类型直腿抬高 试验阳性感觉 减退肌