Kotilainen E
Department of Surgery, University of Turku, Finland.
Ann Chir Gynaecol Suppl. 1994;209:1-50.
During the last two decades, new microinvasive techniques have been introduced into the treatment of lumbar disc herniation. The potential benefits of microinvasive disc surgery are the reduced surgical trauma to the tissue, increased safety due to good visualization of the operation field under the microscope and, consequently, reduced postoperative morbidity and shorter hospitalization in comparison to conventional surgery. In this study, we evaluated the use of microdiscectomy and percutaneous nucleotomy in the treatment of patients with lumbar disc herniation. Of the 237 patients who underwent microdiscectomy for virgin single-level lumbar disc herniation, 92% informed that their sciatic pain had completely recovered or markedly diminished during a median postoperative follow-up of 2 years and 79% of these patients had returned to work. The outcome of the patients operated on for a disc protrusion was to some extent less satisfactory than the outcome of the patients operated on for a prolapse or a sequestrum. Further, of the 45 patients who underwent percutaneous nucleotomy, the sciatic pain had completely recovered or markedly diminished in 38 (84%) patients during a mean postoperative follow-up of 2 years and 78% of them had returned to work. Also in these patients, a protrusion-type of disc herniation was associated with an inferior outcome. After a mean postoperative follow-up of 3 years, the patients treated with microdiscectomy underwent repeated clinical examination. Segmental instability of the lumbar spine was observed in 22% of 190 patients studied. Lumbar instability correlated significantly (P < 0.0001) with an unsatisfactory long-term outcome in these patients. Clinical instability was preoperatively detected in 24% of the 45 patients treated with percutaneous nucleotomy. Also in these patients, instability predicted significantly (P < 0.05) an inferior outcome. On the first postoperative day, there was an extradural hematoma in 86% of the 44 patients studied with MRI. The incidence of hematomas was associated with the surgical method used: all 28 patients treated with microdiscectomy but only 10 (63%) of the 16 patients treated with percutaneous nucleotomy had a hematoma (P = 0.001). In addition, 25 (61%) of the 41 patients studied had an edematous epidural mass effect mimicking preoperative disc herniation. During follow-up for 6 months, the mass effect resolved completely in 10 of these patients but in 15 patients, MRI subsequently revealed either a disc prolapse or a protrusion. In addition, a protrusion was detected in 7 patients with no postoperative mass effect. There was, however, no association between these MRI findings and the clinical outcome of the patients.(ABSTRACT TRUNCATED AT 400 WORDS)
在过去二十年中，新的微创技术已被引入腰椎间盘突出症的治疗。微创椎间盘手术的潜在益处包括对组织的手术创伤减小、由于在显微镜下手术视野清晰而提高了安全性，因此与传统手术相比，术后发病率降低且住院时间缩短。在本研究中，我们评估了显微椎间盘切除术和经皮髓核切除术在治疗腰椎间盘突出症患者中的应用。在237例行初次单节段腰椎间盘突出症显微椎间盘切除术的患者中，92%的患者表示在术后2年的中位随访期内坐骨神经痛已完全恢复或明显减轻，其中79%的患者已恢复工作。接受椎间盘突出手术的患者的结果在某种程度上不如接受椎间盘脱垂或游离手术的患者。此外，在45例行经皮髓核切除术的患者中，在术后2年的平均随访期内，38例（84%）患者的坐骨神经痛已完全恢复或明显减轻，其中78%的患者已恢复工作。在这些患者中，突出型椎间盘突出症的结果也较差。术后平均随访3年后，对接受显微椎间盘切除术治疗的患者进行了重复临床检查。在190例接受研究的患者中，22%观察到腰椎节段性不稳定。腰椎不稳定与这些患者长期预后不满意显著相关（P < 0.0001）。在45例行经皮髓核切除术治疗的患者中，24%在术前检测到临床不稳定。在这些患者中，不稳定也显著预测了较差的结果（P < 0.05）。在术后第一天，44例行MRI检查的患者中有86%出现硬膜外血肿。血肿的发生率与所使用的手术方法有关：28例接受显微椎间盘切除术治疗的患者均出现血肿，但16例行经皮髓核切除术治疗的患者中只有10例（63%）出现血肿（P = 0.001）。此外，41例接受研究的患者中有25例（61%）出现类似术前椎间盘突出症的硬膜外水肿块效应。在6个月的随访期间，其中10例患者的肿块效应完全消退，但15例患者的MRI随后显示椎间盘脱垂或突出。此外，7例无术后肿块效应的患者检测到椎间盘突出。然而，这些MRI结果与患者的临床结局之间没有关联。（摘要截断于400字）
