A prospective, randomized study comparing the results of open discectomy with those of video-assisted arthroscopic microdiscectomy
A prospective, randomized study comparing the results of open discectomy with those of video-assisted arthroscopic microdiscectomy
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DOI：
10.2106/00004623-199907000-00008
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发表时间：
1999-07-01
影响因子：
5.3
通讯作者：
Kambin, P
中科院分区：
文献类型：
--
作者：
Hermantin, FU;Peters, T;Kambin, P
背景：视频辅助关节镜下显微椎间盘切除术治疗腰椎间盘突出症的有效性此前已有研究。在当前这项前瞻性随机研究中，将该手术的结果与传统的开放性椎板切除术和椎间盘切除术的结果进行了比较。
方法：60例有客观证据表明单一腰椎管内椎间盘突出且位于第一腰椎以下的患者被随机分为两组，每组30例；第1组采用开放性椎板切除术和椎间盘切除术治疗，第2组采用视频辅助关节镜下显微椎间盘切除术治疗。所有患者均无腰部手术史，且对非手术治疗措施均无效。对两种手术结果的分析基于患者术前和术后的自我评价、术前和术后的临床发现以及患者恢复功能状态的能力。术后对患者随访19至42个月。
结果：根据患者术前和术后的自我评价、体格检查结果以及患者恢复工作或正常活动的能力，第1组28例患者（93%）和第2组29例患者（97%）被认为有满意的结果。第1组患者能够恢复工作前的平均术后残疾持续时间明显长于第2组（49天比27天）。第1组患者术后使用麻醉剂的时间更长。两组均未出现神经血管并发症或感染。
结论：尽管两组的满意结果率大致相同，但接受关节镜下显微椎间盘切除术的患者术后残疾持续时间更短，使用麻醉剂的时间也更短。这些发现表明，关节镜下显微椎间盘切除术可能对因腰椎间盘突出引起的包括神经根病在内的特定症状的手术治疗有用，但前提是患者要经过适当选择——即，他们必须在影像学检查中证实为单一节段的椎间盘突出，对非手术治疗无效，无椎管狭窄的证据，且突出不超过椎管前后径的一半。此外，外科医生必须熟悉该技术，并接受过使用该技术的培训。
Background: The usefulness of video-assisted arthroscopic microdiscectomy for the treatment of a herniated lumbar disc has been studied previously. In the current prospective, randomized study the results of this procedure were compared with those of conventional open laminotomy and discectomy.Methods: Sixty patients who had objective evidence of a single intracanalicular herniation of a lumbar disc caudad to the first lumbar vertebra mere randomized into two groups consisting of thirty patients each; Group 1 was managed with open laminotomy and discectomy, and Group 2 was managed with video-assisted arthroscopic microdiscectomy, None of the patients had had a previous operation on the low back, and all had failed to respond to nonoperative measures. Analysis of the outcomes of both procedures was based on the patient's self-evaluation before and after the operation, the preoperative and postoperative clinical findings, and the patient's ability to return to a functional status. The patients were followed for nineteen to forty-two months postoperatively.Results: On the basis of the patient's preoperative and postoperative self-evaluation, the findings on physical examination, and the patient's ability to return to work or to normal activity, twenty-eight patients (93 percent) in Group 1 and twenty-nine patients (97 percent) in Group 2 mere considered to have had a satisfactory outcome. The mean duration of postoperative disability before the patients were able to return to work was considerably longer in Group 1 than in Group 2 (forty-nine compared with twenty-seven days). The patients in Group 1 used narcotics for a longer duration postoperatively, No neurovascular complications or infections were encountered in either group.Conclusions: Although the rate of satisfactory outcomes was approximately the same in both groups, the patients who had had an arthroscopic microdiscectomy had a shorter duration of postoperative disability and used narcotics for a shorter period. These findings suggest that arthroscopic microdiscectomy may be useful for the operative treatment of specific symptoms including radiculopathy; that are caused by lumbar disc herniation, provided that patients are properly selected - that is, they must have a herniated disc at a single level as confirmed on imaging studies, have failed to respond to nonoperative management, have no evidence of spinal stenosis, and have a herniation not exceeding one-half of the anteroposterior diameter of the spinal canal. Moreover, the surgeon must be familiar with this technique and must have received training in its use.