本文選題：椎間盤鏡 + 開放髓核摘除術��； 參考：《福建醫(yī)科大學》2015年碩士論文

【摘要】：[目的]比較椎間盤鏡髓核摘除術(MED)與開放椎板開窗髓核摘除術(OD)治療腰椎間盤突出癥的優(yōu)缺點以及臨床療效。[方法]分析2012年3月到2014年5月福建醫(yī)科大學附屬協和醫(yī)院骨科收治的48例腰椎間盤突出癥患者的病例資料,其中行椎間盤鏡下髓核摘除術治療者25例,行開放椎板開窗髓核摘除術者23例。使用統(tǒng)計學方法比較兩組手術時間、術中出血量、切口長度、術后住院時間、術后并發(fā)癥發(fā)生率,并運用Macnab腰椎功能評定標準評估兩組術后一年療效。[結果]兩組患者年齡、性別、病變節(jié)段及病程對比無顯著性差異(P0.05),兩組樣本具有可比性。MED組術中出血量31.72±77.34ml、切口長度2.02±0.20cm、術后住院時間7.04±1.47天,OD組術中出血量107.61±160.03ml、切口長度4.83±1.11cm、術后住院時間8.21±1.63天,MED組術中出血量、切口長度及術后住院時間顯著小于OD組(P0.05),而MED組手術時間109.57±26.24min,OD組手術時間77.50±36.68min,前者手術時間顯著長于后者(P0.05)。MED組術后一年療效優(yōu)病例數19例、良4例、可2例、無療效差病例,優(yōu)良率為92.00%,OD組術后一年療效優(yōu)病例數15例、良6例、可1例、差1例,優(yōu)良率為91.30%,MED組出現1例并發(fā)癥,并發(fā)癥發(fā)生率4%。OD組出現3例并發(fā)癥,并發(fā)癥發(fā)生率13.04%。兩組療效優(yōu)良率及并發(fā)癥發(fā)生率均無統(tǒng)計學差異(P0.05)。[結論]椎間盤鏡髓核摘除術創(chuàng)傷小,術后恢復快,但開展早期手術時間長于開放手術。椎間盤鏡髓核摘除術治療腰椎間盤突出癥具有較佳療效及安全性,與開放椎板開窗髓核摘除術相當。
[Abstract]:[objective] to compare the advantages and disadvantages of MED and ODD in the treatment of lumbar disc herniation. [methods] from March 2012 to May 2014, 48 patients with lumbar disc herniation treated in Department of Orthopaedics, Union Hospital of Fujian Medical University were analyzed. Among them, 25 cases were treated with discectomy. 23 cases underwent open laminectomy of nucleus pulposus. The operative time, intraoperative bleeding volume, incision length, postoperative hospitalization time and postoperative complication rate were compared between the two groups by means of statistical method. Macnab lumbar function evaluation criteria were used to evaluate the curative effect of the two groups one year after operation. [results] Age, sex, There was no significant difference in pathological segment and course of disease between the two groups (P 0.05). The blood loss in MED group was 31.72 鹵77.34 ml, incision length was 2.02 鹵0.20 cm, postoperative hospitalization time was 7.04 鹵1.47 days, intraoperative bleeding volume was 107.61 鹵160.03 ml, incision length was 4.83 鹵1.11 cm, postoperative hospitalization time was 8.21 鹵1.63 days in MED group. The incision length and postoperative hospital stay were significantly shorter than those in OD group (P 0.05), while the operative time in MED group was 109.57 鹵26.24 min. The operative time of the former group was significantly longer than that of the latter group. The excellent and good rate was 92.00%. In the OD group, 15 cases were excellent, 6 cases were good, 1 case was fair, 1 case was poor. The excellent and good rate was 91.30%. The complication rate was 3 cases in 4%.OD group and 13.04% in 4%.OD group. There was no significant difference in the rate of excellent and good curative effect and the incidence of complications between the two groups (P 0.05). [conclusion] discectomy of nucleus pulposus has less trauma and faster recovery, but the early operation time is longer than that of open surgery. The treatment of lumbar disc herniation by endoscopic discectomy is effective and safe, which is similar to that of open laminectomy.
【學位授予單位】：福建醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3

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