青壮年患者单纯腰椎间盘切除术后远期疗效及影响因素

目的：分析青壮年腰椎间盘突出症患者进行单纯腰椎间盘切除术后远期临床效果，并探讨相关影响因素。方法回顾性分析我科1999年12月至2003年3月，经治的34例青壮年腰椎间盘突出症患者的随访资料。临床效果评价指标：VAS 评分、ODI 评分、患者主观满意度、复发及再手术情况等。详细记录病变的节段和突出类型。结果本组34例中男22例，女12例，平均年龄27.6（16～35）岁，平均随访137（120～159）个月。腰腿痛的平均VAS评分术后下降了7.15分。ODI评分术后平均下降了65.05分。末次随访患者对手术主观满意度的优良率为79.4%。性别与 BMI 对 VAS 评分及 ODI 评分的改善无明显影响。病变在L5～S1节段患者的VAS评分和ODI评分的改善优于病变在L4～5节段的患者，差异有统计学意义（ P＜0.05）。非包含型与包含型患者相比，术后ODI及VAS评分改善较好，差异有统计学意义（ P＜0.05）。38.4%的患者（13例）术后症状有复发：9例经保守治疗缓解；2例正在保守治疗；1例因原位复发再次行腰椎间盘切除术；1例因邻近节段突出，原手术节段椎管狭窄行后路腰椎管减压椎弓根钉固定植骨融合术。结论单纯腰椎间盘切除术治疗青壮年腰椎间盘突出症的远期疗效满意，且与性别、身体质量指数（ body mass index，BMI ）无相关性，与病变节段及类型有相关性。青壮年患者术后症状复发率较高，但绝大多数可经保守治疗好转。

Long-term outcomes of simple lumbar discectomy and the associated factors in young adult patients

Objective To analyze the long-term outcomes in young adult patients with lumbar disc herniation undergoing simple lumbar discectomy and to investigate the associated factors. Methods The follow-up data of 34 young adult patients with lumbar disc herniation who were adopted form December 1999 to March 2003 were retrospectively analyzed. The outcomes were assessed using the Visual Analogue Scale （ VAS ）, Oswestry Disability Index （ ODI ）, subjective satisfaction degree in patients, recurrence and need for additional surgery. The lumbar level of herniation and the type of lumbar disc herniation were recorded in detail. Results In this group, 22 males and 12 females were followed up for a mean period of 137 months （range;120-159 months）, whose mean age was 27.6 years old （ range;16-35 years ）. The average VAS score of low back pain and leg pain was reduced by 7.15 points, and the average ODI score was reduced by 65.05 points postoperatively. In the latest follow-up, 79.4%of the patients were satisifed with their surgery. The gender and Body Mass Index （ BMI ） affected the improvement in the VAS and ODI scores slightly. The improvement in the VAS and ODI scores in the patients with disc herniation at the L5-S1 level was superior to the patient with disc herniation at the L4-5 level, and the differences were statistically signiifcant （ P＆lt;0.05 ）. The improvement in the VAS and ODI scores postoperatively in the patients with non-contained disc herniation was better than that in the patients with contained disc herniation, and the differences were statistically signiifcant （ P＆lt;0.05 ）. 38.4%of the patients （ n=13 ） had recurrent symptoms after the surgery. 9 patients got relieved after non-operative treatments, and 2 patients were being treated by non-operative treatments. Only 1 patient underwent lumbar discectomy once again due to recurrence in situ, and another one had posterior spinal canal decompression, pedicle screw ifxation and interbody fusion in the ifrst operation level because of adjacent segment degeneration and stenosis. Conclusions The long-term outcomes of only lumbar discectomy are satisfactory in young adult patients with lumbar disc herniation, which are not relevant to the gender and BMI, but are relevant to the level and type of lumbar disc herniation. The recurrence rate of postoperative symptoms is greater in young adult patients. However, most of them can recover after non-operative treatments.