腰椎间盘突出症术后长期疗效分析

目的探讨开窗减压髓核摘除术治疗腰椎间盘突出症的长期疗效。方法随访采用开窗减压髓核摘除术治疗的82例单节段非特殊类型的腰椎间盘突出症患者,平均随访103个月(84～123个月)。结果术前日本骨科协会(JOA)评分平均为6.5分(5～9分),下腰痛的视觉模拟评分(VAS)为4.8分(0～8分),下肢根性痛的VAS为7.2分(4～10分);术后最终随访时JOA评分平均为13.2分(10～14分),下腰痛的VAS为1.8分(0～10分),下肢根性痛的VAS为1.2分(0～7分)。手术后JOA评分的改善率为78.8%,椎间盘高度比值为80.2%(Moch ida法)。最终随访时有7例复发性椎间盘突出。最终的临床优良率为80%(改良M acnab法)。结论手术指征合适,开窗减压髓核摘除术治疗腰椎间盘突出症能获得较好的长期疗效;手术前后下肢根性痛的改善优于下腰痛;下腰痛的发生和改变与术后椎间隙高度和节段稳定度、椎间盘退变程度以及腰背肌失效有关。

Long-term therapeutic effect of discectomy for lumbar disc herniation

Objective To evaluate the long-term therapeutic effect of discectomy for lumbar disc herniation. Methods Eighty-two cases of lumbar disc herniation,which was one-level and nonspecific in type and treated with simple discectomy were followed up for an average of 103 months(84-123 months). Results The average scores before operation were as follows: JOA,6.5(5-9);VAS of low back pain,4.8(0-8);VAS of sciatica,7.2(4-10).The above scores at the final follow-up were 13.2(10-14),1.8(0-10) and 1.2(0-7),respectively.The average improvement ratio of JOA scale was 78.8%,and the average disc/vertebra height ratio(Mochida method) was 80.2%.At the final follow-up,seven cases of recurrent disc herniation were observed.The final excellent rate was 80%(modified Macnab method). Conclusion With appropriate surgical indications,an established long-term outcomes can be expected with discectomy.Greater relief of sciatica postoperation can be achieved than the low back pain.The occurrence of low back pain is related with the intervertebral disc height,segement stability,disc degeneration and lumbar muscle dysfunction.