内視鏡下腰椎椎間板ヘルニア摘出術の短・中期成績

Short-to Middle-term Outcome of Microendoscopic Discectomy for Lumbar Disc Herniation

　抄録：内視鏡下腰椎椎間板摘出術（microendoscopic discectomy，MED）の短・中期治療成績について調査した．症例はMEDを行った腰椎椎間板ヘルニア102例（男性66例，女性36例，平均年齢36歳，平均調査期間1年4カ月；6カ月～4年2カ月）であった．同じ時期に手術を行ったMED 47例とLove法21例の比較検討も行った．全体の平均改善率は81.2±14.9％と良好であったが，初期の10例でopen conversionを余儀なくされた．また，合併症として硬膜損傷3例，有痛性血腫2例，ヘルニア取り残し2例，術後早期再発6例などがみられた．Love法との比較では改善率や満足度に両群間に有意差はなく，術後CPK，CRP，鎮痛剤使用量，復職に要した日数などはMEDで有意に少なかった．

　MEDはいくつかの合併症のリスクがあるものの，手技に習熟すれば低侵襲で，良好な成績が得られる手術法である．

　The short-to middle-term surgical outcome of microendoscopic discectomy (MED) was reviewed and compared with that of conventional open discectomy to identify the advantages and disadvantages of MED in patients with lumbar disc herniation (LDH). The subjects consisted of 102 patients with LDH (66males, 36 females, mean age 37.6 years) who underwent MED. The average recovery rate in terms of JOA scores was 81.2±14.9％. MED was converted to an open procedure intraoperatively in 10 of the early patients. Complications included dural tears in three patients, residual disc hernia in two patients, hematoma in two patients, and early recurrence in six patients. The surgical outcome in 47 of the patients treated by MED and 21 patients treated by conventional open discectomy during the same period were compared. There was no significant difference in recovery rate or patient satisfaction with the surgical outcome, but the postoperative CPK and CRP levels and total doses of analgesics administered were significantly lower in the MED group. MED is capable of providing surgical outcomes similar to those obtained by the conventional method by means of a less invasive procedure, however, patients should be informed of possible complications, such as dural tears and early recurrence, prior to surgery.