腰椎椎間板ヘルニアに対するMETRx systemを用いたmicro-discectomyの短期成績―同一術者によるLove法との比較検討

Clinical Results of Micro-Discectomy Using the METRx System for Lumbar Disc Herniation : Preliminary Report Based on a Comparative Analysis with Love's Method

　抄録：腰椎椎間板ヘルニア症例に対して，METRx micro-discectomy（METRx MD）と従来のLove法との結果を比較し，本術式の低侵襲性およびその有用性を検討した．同一術者がMETRx MDを行った連続する19例および，Love法を行った連続する17例を対象にした．結果は手術時間はMETRx MDで平均65分，Love法で平均68分とまったく有意差を認めず，さらにMETRx MD導入初期の10例に限ってみても，平均66分とLove法と有意差を認めなかった．また術後6カ月のJOAスコア改善率もそれぞれ86.6％，82.7％とまったく両群間に有意差を認めなかった．一方，術後のジクロフェナック座薬使用個数はMETRx MDが有意に少なく，また血液データでも術後1週のCRP値は有意にMETRx MDで低値を呈した．以上より，METRx MDは低侵襲であり，非常に有用な術式と結論できた．

　We evaluated the usefulness and invasiveness of METRx micro-discectomy (METRx MD) by comparing it with Love's method. Nineteen patients treated by METRx MD and seventeen patients treated by the Love's method, as control group, were included in this study. Every operation in both groups was performed by the same surgeon. Clinical results in the two groups were compared on the basis of 1）operation time, 2）recovery rate according to JOA score, 3）total dose of analgesics administered, and 4）blood study findings, including leukocyte count, erythrocyte sedimentation rate, creatine phosphokinase activity, and C-reactive protein levels. JOA scores were calculated one month following surgery. The total dose of analgesics administered was determined on the basis of times the patient needed suppositories postoperatively as recorded on the medical chart. Operation time averaged 65minutes in the METRx MD group and 68minutes in the Love's group, with no significant difference. Recovery rates based on the JOA score averaged 86.6％ and 82.7％, respectively, with no significant difference. Howeber, the average total dose of analgesics administered postoperatively was “0.2 times” in the METRx MD group, and “0.9 times” in the Love's group, and it was significantly higher in the Love's group. The C-reactive protein level one week postoperatively was significantly lower in the METRx MD group than in the Love's group. The METRx MD method does not require any special training, and it provided good results, similar to Love's method. It had the advantage of being less invasive than Love's method, and we concluded that METRx MD is a useful procedure for the treatment of lumbar disc herniation.