腰椎间盘突出症手术时机对术后疗效的影响

目的 探讨腰椎间盘突出症患者手术时机对术后疗效的影响.方法 采用回顾性对比研究的方法,以12个月为手术时机时限,将85例因腰椎间盘突出症行微创腰椎间盘切除术的患者分为A组43例（≥12个月）和B组42例（＜12个月）,对术前及术后下肢疼痛视觉模拟评分（VAS）、功能障碍指数（ODI）评分及日本整型外科学会（JOA）评分改善率进行统计学分析.结果 本研究共对85例患者进行了随访调查.术前症状持续时间A组36.0（12.0,84.0）个月,B组2.5（2.0,4.2）个月.下肢疼痛VAS评分A组术前为6.0（5.0,8.0）分,术后为1.0（0.0,1.0）分;B组术前为5.0（4.8,8.0）分,术后为0.0（0.0,2.0）分.2组对比,术前（t =0.868,P=0.390）;术后（t=1.530,P=0.133）,差异无统计学意义.ODI评分A组术前为57.0％ （42.0％,75.0％）,术后为15.0％（8.0％,21.0％）;B组术前为57.5％ （44.2％,76.0％）,术后为11.0％（4.8％,18.0％）.2组对比,术前（t=-0.396,P=0.694）;术后（t=1.399,P=0.169）,差异无统计学意义.JOA评分改善率A组（78±24）％,B组（86±17）％,t=-1.322,P=0.193,差异无统计学意义.结论 微创腰椎间盘切除术治疗腰椎间盘突出症疗效是肯定的.本研究选取12个月作为手术时机时限进行回顾性对比分析,发现术后疗效差异无统计学意义.

Influence of operation time on the postoperative clinical outcomes of lumbar disc herniation

Objective To evaluate whether an optimistic operation time can change the outcomes of the lumbar disc herniation patients.Methods A total of 85 patients with lumbar disc herniation treated by minimal invasive discectomy were reviewed.Surgery was performed when leg pain persisted even with adequate conservative treatment.The patients were divided into two groups according to the duration of symptoms before surgery：the group A were the patients having symptoms for over or equal to 12 months and the group B were the patients having symptoms for fewer than 12 months.Leg pain visual analogue scale（VAS）,the oswestry disability index （ODI） and lumbar Japanese orthopaedic association （JOA） score were assessed and compared before and after surgery.Results There were 43 patients in group A and 42 patients in group B.The duration of symptoms was 36.0 （12.0,84.0） months in group A and 2.5 （2.0,4.2） months in group B.No significant differences were found between the groups in terms of patient demographics （age,sex,body mass index,type of herniation）,surgical time and blood loss.There were no significant differences of VAS between the groups.The VAS scores before operation were group A 6.0（5.0,8.0） vs group B 5.0（4.8,8.0） （t =0.868,P =0.390）,while the post-operation VAS were group A 1.0 （0.0,1.0） vs group B 0.0 （0.0,2.0） （t =1.530,P =0.133）.There were no significant differences of ODI scores between the groups.The pre-operation ODI scores were group A 57.0% （42.0%,75.0%） vs group B 57.5% （44.2%,76.0%） （t =-0.396,P =0.694）,while the post-operation ODI scores were group A 15.0% （8.0%,21.0%） vs group B 11.0% （4.8%,18.0%） （t =1.399,P =0.169）.In addition,there were no significant differences between group A and group B based on lumbar JOA scores：group A （78 ±24）% vs group B （86 ± 17）% （t =-1.322,P =0.193）.Conclusions The minimal invasive discectomy is effective treating the lumbar disc herniation.Early surgical intervention （〈 12 months） does not result in signif-icant imorovement of clinical outcomes for patients with lumbar disc herniation.