Analiza razlika u kliničkom toku i ishodu operativnog lečenja pacijenata obolelih usled lumbalne diskus hernije nakon standardne i mikrodiskektomije
Analysis of differences in the clinical course and outcome of operative treatment after standard lumbar discectomy and microdisectomy
Метаподаци
Приказ свих података о дисертацијиСажетак
Standardna diskektomija (SD) je prvi put upotrebljena u svrhu
lečenja lumbalne diskus hernije (LDH) 1932. godine, dok je mikrodiskektomija (MD)
uvedena u kliničku praksu krajem 70ih godina dvadesetog veka. U poređenju sa SD, MD je
omogućila bolju vizuelizaciju odnosa neuralnih struktura i patološkog supstrata uz
značajno manju jatrogenu traumu. Iako se po mišljenju brojnih autora MD smatra za
zlatni standard hirurškog lečenja LDH, u svakodnevnoj kliničkoj praksi mnogih
centara dve hirurške metode imaju ravnopravan status. Cilj našeg istraživanja je bio
da se uporede klinički tok, učestalost komplikacija i reoperacija, kao i krajnji
funkcionalni ishod lečenja nakon MD i SD. Glavno pitanje našeg istraživanja je bilo
da li je opravdano da dva modaliteta operativnog lečenja u našoj kliničkoj praksi budu
ravnopravna. Istraživanje je dizajnirano kao klinička opservaciona, nerandomizirana
prospektivna studija i njom je obuhvaćeno 206 pacijenata koji su operativno lečeni
usled LDH ...na jednom spinalnom nivou, tokom trogodišnjeg perioda. Za procenu ishoda
lečenja su korišćeni upitnici za pacijenta koji su bili sastavljeni iz Oswestry
Disability Index-a (ODI) i vizuelno-analognih (VA) skala za bol. Kao dopuna studiji
sprovedena je i retrospektivna analiza stope rekurentne diskus hernije koja je zahtevala
reoperaciju, koja je obuhvatila 545 pacijenata tokom devetogodišnjeg perioda. Naši
rezultati su pokazali da je mikrodiskektomija udružena sa značajno nižom stopom
reoperacije, kraćom hospitalizacijom i manjom postoperativnom upotrebom analgetika,
ali i dužim vremenom trajanja operacije. Takođe zadovoljstvo pacijenata operativnim
lečenjem, na osnovu indeksa zadovoljstva, je bilo značajno bolje nakon MD. Ipak
funkcionalni ishod lečenja i redukcija bolnog sindroma (prema ODI i VA skalama) nisu
bili povezani sa izborom hirurške metode. Na pozitivan ishod operacije su uticali i
kraće trajanje preoperativnih tegoba i preoperativna fizikalna terapija. Iz dobijenih
rezultata se može zaključiti da treba dati prednost MD u odnosu na SD, ali i da je to
metoda koja u skladu sa razvojem racionalnijeg zdravstvenog sistema.
Standard discectomy (SD) was first used for the treatment of lumbar disc herniation
(LDH) in 1932, while microdiscectomy (MD) was introduced into clinical practice at the end of
the 1970's. Compared to SD, MD has enabled better visualization of the relationship between
neural structures and pathological substrate with significantly less iatrogenic trauma. Although
MD is considered a gold standard for surgical treatment of LDH by many authors, the daily
clinical practice of many centers shows that the two surgical methods have equal status. The aim
of the study was to compare the clinical course, the frequency of complications and reoperations,
and the ultimate functional outcome of treatment after MD and SD. The main issue of the
research was is the equality of the two operative treatment modalities in our clinical practice
justified. The study was designed as an observational clinical, non-randomized prospective study,
encompassing 206 patients who were operatively treated f...or LDH at a single spinal level over the
three-year period. For an outcome assessment, in patient questionnaires both the Oswestry
Disability Index (ODI) and the Visual Analogue (VA) scales were used. In addition to the study,
a retrospective analysis of the rate of recurrent disc herniation requiring reoperation was carried
out. It included 545 patients during the nine-year period. The results have shown that
microdiscectomy is associated with a significantly lower rate of reoperation, shorter
hospitalization, reduced use of analgesics postoperatively, as well as an increased duration of
operation. Also, based on satisfaction index, patient satisfaction with operative treatment was
significantly higher after MD. However, the functional outcome of treatment and reduction of
pain syndrome (according to ODI and VA scales) were not related to the choice of surgical
method. The positive outcome of surgery was also affected by shorter duration of preoperative
symptoms and preoperative physical therapy. According to the obtained results it can be
concluded that MD should be given priority over SD, but also that it's a method in accordance
with the development of a more efficient health care system.