108例腰椎间盘突出并椎管狭窄患者腰痛原因及手术疗效分析

目的①分析腰椎间盘突出并椎管狭窄患者腰痛的原因。②观察后路腰椎间融合治疗腰椎间盘突出并椎管狭窄的手术疗效。方法收集2007年1月～2008年1月在暨南大学附属第一医院骨科确诊为腰椎间盘突出并椎管狭窄行后路腰椎间融合术的108位患者的临床资料。所有患者经X线片及CT或MRI片确诊。采用X线动力位片测量以腰痛为主要症状和以下肢痛为主要症状的患者腰椎椎体间角度变化及椎体移位程度,以比较两者术前腰椎失稳和腰椎生理性前凸消失的发生率,并观察患者术后腰腿痛的缓解情况。结果①以腰痛为主的患者腰椎失稳和腰椎生理性前凸消失的发生率高于以下肢疼痛为主的患者。②术后患者腰腿痛症状明显减轻,JOA评分改善,患者腰椎失稳消失,腰椎生理性前凸部分恢复。结论①腰椎失稳和腰椎生理性前凸消失是腰椎间盘突出并椎管狭窄患者腰痛的重要原因。②后路腰椎间融合术可明显减轻腰椎间盘突出合并椎管狭窄患者腰腿痛症状,疗效确切,是临床较好治疗方法之一。

Analysis of the cause and the therpentic effect of back pain in 108 patients with lumbar disc herniation and lumbar stenosis

Objective ①To investigate the cause of back pain in the patients with lumbar disc herniation and lumbar stenosis.②To investigate the therpeutic effect of posterior lumbar intrebody fusion for the patients with lumbar disc herniation and lumbar stenosis.Methed 108 patients with lumbar disc herniation and lumbar stenosis,who have underwent posterior lumbar intrebody fusion from 2007-1 to 2008-1,were investigated.The lumbar disc herniation and lumbar stenosis are assertive in all patients with X-Ray and CT.The range of intervertebral level transition and angle transition are measured with X-Ray.The preoperative data on the rate of segmental instability,loss of lumbar lordosis of the patients with severe back pain were compared with those of patients with severe leg pain.The therpeutic effect of posterior lumbar intrebody fusion was observed.Result ①The rates of segmental instability,loss of lumbar lordosis of the patients with severe back pain were higher than those of patients with severe leg pain.②After the surgery,the patients back pain was much relieved,JOA score was improved,the segmental instability disappear,the lumbar lordosis was restored.Conclusion ① Segmental instability and loss of lumbar lordosis are important causes due to back pain of lumbar disc herniation and lumbar stenosis.②Posterior lumbar intrebody fusion could greatly relieve the patients back pain,and the therpeutic effect is assertive.Posterior lumbar intrebody fusion is one of reasonable treatment options for the patients with lumbar disc herniation and lumbar stenosis.