巨大型腰椎椎间盘突出症的外科治疗

目的：探讨巨大型腰椎椎间盘突出症的发病特点及手术疗效。方法回顾分析5年来手术治疗的腰椎椎间盘突出症患者共1441例，将其分为巨大型172例、普通型1269例，随访记录其发病年龄、性别、症状特点、突出形态、手术方式、手术并发症、术后疗效、术后复发率等，并行统计学对比分析2组在各方面的异同。结果1441例患者资料完整，总体男女比2．99∶1，平均年龄43．4岁。2组之间比较：平均年龄2组之间差异无统计学意义（ P＞0．05）；性别比例均为男性好发，巨大型组男女比明显低于普通型组（P＜0．05）；平均病程巨大型组明显短于普通型组（P＜0．05）；巨大型组与普通型组相比，双侧症状更多、肌力下降者更多、马尾综合征更多、中央型比例更高、椎间盘脱出者更多（P＜0．01）；巨大型组中实施双侧减压明显高于普通型组（P＜0．01）；手术并发症发生率，包括术中脑脊液漏发生率、切口感染率、深部感染率2组之间差异无统计学意义（P＞0．05）；手术优良率分别为94．12％、93．78％，2组之间差异无统计学意义（P＞0．05）；术后复发率巨大型组明显低于普通型组（P＜0．05）。结论巨大型腰椎椎间盘突出症与普通型相比有截然不同的临床特点，其手术治疗可达到等同于普通型的良好疗效，术后复发率低于普通型腰椎椎间盘突出症。

Surgical treatments of huge lumbar disc herniation

Objective To explore the epidemiological characteristics, clinical features and operational outcome of huge lumbar disc herniation.Methods A total of 1 441 patients with lumbar disc herniation accepting surgical treatments including 172 cases of huge lumbar disc herniation（HLDH） and 1 269 cases of no huge lumbar disc herniation（NHLDH） were retro-spectively analyzed.Gender, age, clinical manifestation, levels of disc herniation, herniation morphology, surgical approach, surgical outcomes and recurrence rate were recorded and statistically analyzed.Results All of 1 441 patients were completely recorded.The total male/female ratio is 2.99∶1, and the average age was 43.4 years.Between the 2 groups, the average age was not significantly different（P〉0.05）.The male-female ratio of HLDH was significantly smaller than that of NHLDH（P〈0.05）.HLDH had a smaller duration of symptoms than NHLDH（P〈0.05）.Compared with NHLDH, HLDH were more prone to be non-contained, centralherniation and present bilateral symptoms, motor deficit, caudaequina syndrome （ P〈0.01）.Patients with HLDH accepted more bilateral laminectomies（P〈0.001）.And the outcome of operation, complications of dural tear, superficial wound infection, deep wound infection showed no differences between the 2 groups（P〉0.05）. Recurrence rate of HLDH was significantly lower than that of NHLDH（P〈0.05）.Conclusion Compared with NHLDH, HLDH has distinct clinical features, equally satisfactory operation outcomes and a lower postoperational recurrence rate.