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1、显微镜下椎间盘摘除术治疗腰椎间盘突出症成本强彭新生龙朝仪 肇庆市第一人民医院骨外科中山大学附属第一医院脊柱外科【摘要】：目的：观察在手术显微镜下完成腰椎间盘突出髓核摘除术的疗效。方法：分别选取40例住院行显微镜椎间盘切除术(microsurgicallumbardiscectomy,MSLD)和传统手术(openlumbardiscectomy,OLD)治疗单节段腰椎间盘突出症的患者,比较2种手术的切口长度、手术时间、出血量、住院天数,手术后JOA、VAS和ODI改善率情况。结果：MSLD组及OLD组的切口长度分别为
2、(2.6±0.8)cm和(5.4±1.8)cm,手术时间分别为(56.0±16.9)min和(71.0±30.5)min,出血量分别为(86.0±33.0)mL和(110.0±47.0)mL,住院天数分别为(9.2±2.5)d和(11.2±3.6)d,2组间差异有统计学意义(P0.01)。术后3个月随访时,MSLD组及OLD组的JOA改善率分别为85.3%±8.2%和84.9%±7.5%,VAS改善率分别为86.4%±1.8%和84.4%±2.0%,ODI改善率分别为81.5%±6.2%和80.8%±5.5%,两组间
3、比较差异无统计学意义(P0.05)。结论：显微镜下完成腰椎间盘突出髓核摘除术的切口小,术中出血量少,视野清晰,可减少对神经根及硬膜囊的手术刺激,安全、可靠,术后病人切口痛苦明显减少,术后恢复快及疗效满意,是治疗腰椎间盘突出症一种较好的手术方法。但显微镜下椎间盘摘除术的熟练操作需要较长时间的显微外科训练基础，学习时间曲线较长。【关键词】腰椎间盘突出症；微创；显微镜ClinicaleffectsofLumbarDiscHerniationbyminimallyinvasivemicroscopysurgeryDepart
4、mentofOrthopaedics，BeijingTiantanHospitalaffiliatedtoCapitalMedicalUniversity【Abstract】Objective:Toevaluatetheefficiencyofsurgicaltreatmentoflumbardischerniationbymicrosurgicallumbardiscectomy(MSLD).Methods:Aclinicalreviewwasconductedonthetwosurgicalmethodsfors
5、inglesegmentlumbardischerniation(LDH)fromApril2007toJune2010,onegroupof30patientswhounderwentmicrosurgicallumbardiscectomy(MSLD)andtheotherof30patientswhounderwentopenlumbardiscectomy(OLD).Thefactorsconsideredincludedthelengthofskinincision,theoperativetime,amo
6、untofintraoperativebleeding,durationofhospitalization,pre-andpostoperativeassessmentbasedonthecriteriaofJapaneseOrthopaedicAssociationScores,visualanalogscaled(VAS),theOswestrydisabilityindex(ODI).Results:Themeanlengthofskinincisionwas2.8±0.8cmand5.5±1.8cm,theo
7、perativetimewas57.0±16.9minand72.0±30.5min,thebloodlosswas85±33mland110±48ml,thehospitalizationtimewas10.2±2.5daysand12.2±3.6daysforMSLDandOLDrespectively.Allhadsignificantdifference(P<0.01).Threemonthsaftertheoperation,theimprovementrateofJOAwas（85.3±8.3）％and（
8、84.9±7.6）％forMSLDandOLDrespectively.TheimprovementrateofVASscorewas（86.4±1.9）％.and（84.4±2.1）％forMSLDandOLDrespectively.TheimprovementrateofODIscorewas（81.5±6.3）％and（80.8±5.6
