[1]李永刚,韦继南,陆军,等.椎间盘镜下髓核摘除术和经皮椎间盘切吸术治疗单节段中央型椎间盘突出症的远期疗效比较[J].介入放射学杂志,2012,(01):40-44.
　LI Yong-gang,WEI Ji-nan,LU Jun,et al.The long-term therapeutic effect of central lumbar intervertebral disc herniation: a comparison between microendoscopy discectomy and percutaneous lumbar discectomy[J].journal interventional radiology,2012,(01):40-44.
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椎间盘镜下髓核摘除术和经皮椎间盘切吸术治疗单节段中央型椎间盘突出症的远期疗效比较()

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《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
期数:
2012年01期
页码:
40-44
栏目:
非血管介入
出版日期:
2012-01-30

文章信息/Info

Title:
The long-term therapeutic effect of central lumbar intervertebral disc herniation: a comparison between microendoscopy discectomy and percutaneous lumbar discectomy
作者:
李永刚; 韦继南; 陆军; 王宸; 吴小涛; 何仕诚; 滕皋军
210009  南京东南大学附属中大医院骨科
Author(s):
 LI Yong-gang;  WEI Ji-nan;  LU Jun;  WANG Chen;  WU Xiao-tao;  HE Shi-cheng;  TENG Gao-jun.
 Department of Osteologia, the Affiliated Zhongda Hospital, Southeast University, Nanjing, Jiangsu Province 210009, China
关键词:
 ; 【关键词】 腰椎间盘突出;  椎间盘镜下髓核摘除术;  经皮椎间盘切吸术;  远期疗效
文献标志码:
A
摘要:
 【摘要】 目的 比较椎间盘镜下髓核摘除术(MED)与经皮椎间盘切吸术(PLD)治疗中央型腰椎间盘突出症的适应证。远期疗效及并发症,探讨两种术式的临床应用优势。方法 回顾性分析2000年1月至2002年3月行手术治疗的单节段中央型腰椎间盘突出症患者,其中应用MED治疗23例,应用PLD治疗40例,分别比较两组手术适应证范围,病变节段,手术时间和出血量,术后卧床时间,术后住院时间,Oswestry功能障碍指数(oswestry disability index, ODI)及MacNab评分。用配对t检验κ检验及Fisher精确概率法等方法进行统计学分析。结果 MED组平均随访时间为(5.1 ± 0.6)年,PLD组平均随访期为(6.6 ± 0.7)年。MED组的远期ODI、MacNab评分要好于PLD组,而MED组的住院时间、住院费用则明显长于或多于后者,两组比较差异有统计学意义;远期并发症发生率分别为MED组3.49%,PLD组未出现手术相关并发症。结论 MED及PLD治疗腰椎间盘突出症均具有创伤小、恢复快、长期疗效好的特点,PLD临床普及率广,而MED相对学习曲线长,技术要求较高,手术风险较大,但MED的临床远期疗效高于PLD。

参考文献/References:

[1] 陆裕朴, 胥少汀, 葛常丰, 等. 实用骨科学[M]. 北京: 人民军医出版社, 1991: 1141 - 1170.
[2] Teng GJ. Automated percutaneous lumbar discectomy with a new self-made instrument: experimented study and early clinical results[J]. J Interv Radiol, 1994, 9: 81 - 83.
[3] Teng GJ, Jeffery RF, Guo JH, et al. Automated percutaneous lumbar discectomy: a prospective multi-institutional study[J]. J Vasc Interv Radiol, 1997, 8: 457 - 463.
[4] Wu X, Zhuang S, Mao Z, et al. Microendoscopic discectomy for lumbar disc herniation: surgical technique and outcome in 873 consecutive cases[J]. Spine (Phila Pa 1976), 2006, 31: 2689 - 2694.
[5] 罗家明, 吴小涛, 茅祖斌, 等. 脊柱后路显微内镜椎间盘切除术治疗青少年腰椎间盘突出症25例[J]. 中国微创外科杂志, 2006, 6: 488 - 489.
[6] Liu WG, Wu XT, Guo JH, et al. Long-term outcomes of patients with lumbar disc herniation treated with percutaneous discectomy: comparative study with microendoscopic discectomy[J]. Cardiovasc Intervent Radiol, 2010, 33: 780 - 786.
[7] Fairbank JC, Pynsent PB. The oswestry disability index[J]. Spine (Phila Pa 1976), 2000, 25: 2940 - 2952.
[8] Shamim MS, Parekh MA, Bari ME, et al. Microdiscectomy for lumbosacral disc herniation and frequency of failed disc surgery[J]. World Neurosurg, 2010, 74: 611 - 616.
[9] Anthony TY, Christopher AY. Minimally invasive techniques for the management of lumbar disc herniation[J]. Orlhop Clin North Am, 2007, 38: 363 - 372.
[10] Oppenheimer JH, Decastro I, Mcdonnell DE. Minimally invasive spine technology and minimally invasive spine surgery: a historical review[J]. Neurosurg Focus, 2009, 27: E9.
[11] Yeung AT, Yeung CA. Minimally invasive techniques for the management of lumbar disc herniation[J]. 0rthop Clin N Am, 2007, 38: 363 - 372.
[12] Foley KT, Smith MM.Microendoscopic discectomy[J]. Tech Neurosurg, 1997, 3: 301 - 307
[13] 马胜忠, 侯铁胜, 李 明, 等. MED与APLD治疗腰椎间盘突出症的疗效比较[J]. 中国脊柱脊髓杂志, 2002, 12: 48 - 49.
[14] Kambin P, discectomy BP. Anatomy and mechanism[J]. Clin Orthop Relat Res, 1987, 223: 145 - 154.
[15] Dullerud R, Nakstad PH. Side effects and complications of automated percutaneous lumbar nucleotomy[J]. Neuroradiology, 1997, 39: 282 - 285.
[16] 彭 勇, 魏梦绮, 吴 娟, 等. 臭氧治疗术在复杂性腰椎间盘突出症治疗中的临床观察[J]. 介入放射学杂志, 2010, 19: 62 - 65.
[17] 杨维权, 刘大雄, 孙荣华, 等. 后中路椎间盘镜的适应证[J]. 中国矫形外科杂志, 2002, 10: 862 - 865.
[18] 孔翔飞, 吴小涛, 卜星平, 等. 椎板间隙入路椎间盘镜治疗特殊类型腰椎间盘突出症[J]. 中国脊柱脊髓杂志, 2002, 12: 52 - 54.
[19] Zllner J, Heine J, Eysel P. Effect of enueleation on the biomechanicabehaviorof the lumbar motion segment[J]. Zentralbly Neurochir, 2000, 61: 138 - 142.
[20] 李永刚, 吴小涛. 建立后路内窥镜椎间盘切除术工作通道时的手术技巧[J]. 中国脊柱脊髓杂志, 2003, 13: 426 - 428.
[21] 吴小涛, 陈 辉, 卜星平, 等. 经椎板间隙入路内窥镜下髓核摘除术并发症的预防与处理[J]. 中国微创外科杂志, 2001, 1: 354 - 355.
[22] Rong LM, Xie PG, Shi DH, et al. Spinal surgeons＇ learning curve for lumbar microendoscopic discectomy: a prospective study of our first 50 and latest 10 cases[J]. Chin Med J (Engl), 2008, 121: 2148 - 2151.

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 (收稿日期:2011-05-20)
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