本文選題：椎間盤(pán)鏡 + 開(kāi)放髓核摘除術(shù)��； 參考：《福建醫(yī)科大學(xué)》2015年碩士論文

【摘要】：[目的]比較椎間盤(pán)鏡髓核摘除術(shù)(MED)與開(kāi)放椎板開(kāi)窗髓核摘除術(shù)(OD)治療腰椎間盤(pán)突出癥的優(yōu)缺點(diǎn)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(xué)附屬協(xié)和醫(yī)院骨科收治的48例腰椎間盤(pán)突出癥患者的病例資料,其中行椎間盤(pán)鏡下髓核摘除術(shù)治療者25例,行開(kāi)放椎板開(kāi)窗髓核摘除術(shù)者23例。使用統(tǒng)計(jì)學(xué)方法比較兩組手術(shù)時(shí)間、術(shù)中出血量、切口長(zhǎng)度、術(shù)后住院時(shí)間、術(shù)后并發(fā)癥發(fā)生率,并運(yùn)用Macnab腰椎功能評(píng)定標(biāo)準(zhǔn)評(píng)估兩組術(shù)后一年療效。[結(jié)果]兩組患者年齡、性別、病變節(jié)段及病程對(duì)比無(wú)顯著性差異(P0.05),兩組樣本具有可比性。MED組術(shù)中出血量31.72±77.34ml、切口長(zhǎng)度2.02±0.20cm、術(shù)后住院時(shí)間7.04±1.47天,OD組術(shù)中出血量107.61±160.03ml、切口長(zhǎng)度4.83±1.11cm、術(shù)后住院時(shí)間8.21±1.63天,MED組術(shù)中出血量、切口長(zhǎng)度及術(shù)后住院時(shí)間顯著小于OD組(P0.05),而MED組手術(shù)時(shí)間109.57±26.24min,OD組手術(shù)時(shí)間77.50±36.68min,前者手術(shù)時(shí)間顯著長(zhǎng)于后者(P0.05)。MED組術(shù)后一年療效優(yōu)病例數(shù)19例、良4例、可2例、無(wú)療效差病例,優(yōu)良率為92.00%,OD組術(shù)后一年療效優(yōu)病例數(shù)15例、良6例、可1例、差1例,優(yōu)良率為91.30%,MED組出現(xiàn)1例并發(fā)癥,并發(fā)癥發(fā)生率4%。OD組出現(xiàn)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(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。[結(jié)論]椎間盤(pán)鏡髓核摘除術(shù)創(chuàng)傷小,術(shù)后恢復(fù)快,但開(kāi)展早期手術(shù)時(shí)間長(zhǎng)于開(kāi)放手術(shù)。椎間盤(pán)鏡髓核摘除術(shù)治療腰椎間盤(pán)突出癥具有較佳療效及安全性,與開(kāi)放椎板開(kāi)窗髓核摘除術(shù)相當(dāng)。
[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(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R687.3

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