开窗髓核切除术与显微镜下开窗髓核切除术治疗腰椎间盘突出症的随机对照研究。

Open fenestration discectomy versus microscopic fenestration discectomy for lumbar disc herniation: a randomized controlled trial.

机构信息

Department of Orthopaedics, College of Medicine, Hawler Medical University, Erbil, Iraq.

Department of Neurosurgery, College of Medicine, Hawler Medical University, Erbil, Iraq.

出版信息

BMC Musculoskelet Disord. 2020 Jun 15;21(1):384. doi: 10.1186/s12891-020-03396-x.

BACKGROUND

Fenestration discectomy, for symptomatic lumbar disc herniation, is the most common surgical procedure in spine surgery. It can be done by open or microscopic procedures. This study compared the results of fenestration microdiscectomy with open fenestration discectomy in the treatment of symptomatic lumbar disc herniation as a relation to the functional outcome, leg pain, back pain, hospital stay, returns to daily activity, cost, recurrence, reoperation and type of surgery for recurrent disc herniation.

METHODS

60 patients age (29 - 50 years), with L4-L5 disc herniation, are divided randomly into group A- 30 patients underwent an open fenestration discectomy- and group B- 30 patients underwent fenestration microdiscectomy. All patients are assessed at 1 week, 3 months, 6 months, 12 months after surgery for Oswestry disability index and Visual analogue scale for back pain and leg pain and followed up for 4 years.

RESULTS

In both groups, all patients have minimal disability by Oswestry Disability Index after surgery. There were significant differences between means of post-operative Visual Analogue Scale for back pain between these two groups after 1 week (3.7 in group A versus 2.2 in group B) (t = 13.28, P = < 0.001*) and after 3 months (1.73 in group A versus 0.43 in group B) (t = 10.54, P = < 0.001*). There were no significant differences between two groups regarding post-operative VAS for leg pain, recurrence (5 patients in group A versus 4 patients in group B) and reoperation rate (2 patients in each group). There were significant differences between means of length of hospital stay (2.10 in group A versus 1.06 in group B) (P < 0.001), time of returning to daily activities (7.33 in group A versus 4.03 in group B) (P < 0.001) and cost of surgery (1996.66 in group A versus 3003.3 in group B) (P < 0.001).

CONCLUSION

Use of microscope in fenestration discectomy for treatment of symptomatic lumbar disc herniation can achieve the same goals of open fenestration regarding nerve root decompression and relief of leg pain with advantage of less back pain, less hospital staying and early return to daily activities with disadvantage of more cost with the use of microscope. With 4 years follow up, there was no significant deference in rate of recurrence and reoperation with the use of microscope but we found that type of surgery for recurrent cases may be less invasive if microscope was used in primary surgery.

TRIAL REGISTRATION

NCT, NCT04112485. Registered 30 September 2019 - Retrospectively registered, https://clinicaltrials.gov/NCT04112485.

背景

对于有症状的腰椎间盘突出症，开窗髓核切除术是脊柱外科最常见的手术。它可以通过开放或显微镜手术进行。本研究比较了开窗显微椎间盘切除术与开放式开窗椎间盘切除术治疗有症状腰椎间盘突出症的结果，与功能结果、腿痛、腰痛、住院时间、恢复日常活动、成本、复发、再手术以及复发性椎间盘突出症的手术类型有关。

方法

60 名年龄（29-50 岁）为 L4-L5 椎间盘突出症的患者随机分为 A 组（30 例接受开放式开窗椎间盘切除术）和 B 组（30 例接受开窗显微椎间盘切除术）。所有患者均在术后 1 周、3 个月、6 个月、12 个月时进行 Oswestry 残疾指数和视觉模拟量表（VAS）评估腰痛和腿痛，并随访 4 年。

结果

两组患者术后 Oswestry 残疾指数评分均显示出最低的残疾程度。两组术后第 1 周（A 组 3.7，B 组 2.2）（t=13.28，P<0.001*）和第 3 个月（A 组 1.73，B 组 0.43）（t=10.54，P<0.001*）时的术后 VAS 腰痛评分存在显著差异。两组术后腿痛 VAS、复发率（A 组 5 例，B 组 4 例）和再手术率（两组各 2 例）均无显著差异。两组间住院时间（A 组 2.10，B 组 1.06）（P<0.001）、恢复日常活动时间（A 组 7.33，B 组 4.03）（P<0.001）和手术费用（A 组 1996.66，B 组 3003.3）（P<0.001）存在显著差异。

结论

在治疗有症状的腰椎间盘突出症时，显微镜下开窗椎间盘切除术与开放式开窗椎间盘切除术一样可以达到神经根减压和缓解腿痛的目的，但具有腰痛减轻、住院时间缩短和早期恢复日常活动的优势，缺点是显微镜使用的成本较高。在 4 年的随访中，显微镜的使用在复发率和再手术率方面没有显著差异，但我们发现，如果显微镜在初次手术中使用，复发性病例的手术类型可能更具微创性。