Harrington J F, French P
Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island 02905, USA.
Minim Invasive Neurosurg. 2008 Feb;51(1):30-5. doi: 10.1055/s-2007-1004543.
To determine if a minimally invasive approach to lumbar microdiscectomy reduces post-operative pain, length of hospital stay, or frequency of complications we retrospectively compared medical records of single level microdiscectomy patients by a single surgeon performed using a traditional open approach versus a minimally invasive approach. Thirty-five patients were in the open group: 63% male, average age 41.2 years, and 31 patients were in the minimally invasive group: 68% male, average age 42.1 years. There was no difference in surgical time or blood loss between the open and minimally invasive groups: 84.1 versus 76.8 minutes and 51.4 versus 69.7 mL, respectively. There were no significant complications intraoperatively or within the 30 day post-op period for either group. The average dose of intravenous morphine taken was 12.9 mg for the minimally invasive group and 15.7 mg for the open group (P=0.04). The average dose of hydrocodone was 13.4 mg for the minimally invasive group and 20.9 mg for the open group (P=0.03). The open group took an average of 11.7 mg oxycodone, the minimally invasive none. 45.2% of patients in the minimally invasive group were discharged on the same day as surgery compared to 5.75% in the open group (P=0.001). Microdiscectomy was performed safely and effectively through a minimally invasive expanding retractor system and operating microscope. Surgical times, blood loss, complications, and outcome were similar to a traditional open microdiscectomy while pain medication requirements and hospitalization were significantly less.
为了确定腰椎间盘显微切除术的微创方法是否能减轻术后疼痛、缩短住院时间或降低并发症发生率，我们回顾性比较了由同一位外科医生采用传统开放手术方法与微创方法进行的单节段椎间盘显微切除术患者的病历。开放组有35例患者：男性占63%，平均年龄41.2岁；微创组有31例患者：男性占68%，平均年龄42.1岁。开放组和微创组之间的手术时间和失血量没有差异：分别为84.1分钟对76.8分钟和51.4毫升对69.7毫升。两组在术中及术后30天内均无显著并发症。微创组静脉注射吗啡的平均剂量为12.9毫克，开放组为15.7毫克（P = 0.04）。微创组氢可酮的平均剂量为13.4毫克，开放组为20.9毫克（P = 0.03）。开放组平均服用11.7毫克羟考酮，微创组未服用。微创组45.2%的患者在手术当天出院，而开放组为5.75%（P = 0.001）。通过微创扩张牵开器系统和手术显微镜安全有效地进行了椎间盘显微切除术。手术时间、失血量、并发症和结果与传统开放椎间盘显微切除术相似，但止痛药物需求和住院时间明显减少。
