非手术治疗破裂型腰椎间盘突出症5年随访研究

目的:探讨非手术治疗破裂型腰椎间盘突出症的近中期疗效及预后转归。方法:选取2011年2月至2014年2月接受非手术治疗的75例单节段破裂型腰椎间盘突出症患者进行前瞻性研究,男53例,女22例;年龄18～58(35.62±9.96岁);病程5 d～6个月,平均(46.45±40.66) d。突出节段:L_(3,4) 4例,L_(4,5) 29例,L_5S_1 42例。放射痛左侧46例,右侧29例。选取治疗前,治疗后3个月、6个月、1年、2年、5年6个时间点对患者JOA评分、直腿抬高角度(SLRT)、指地距统计分析。计算末次随访时(治疗后5年)JOA改善率,根据JOA评分评定疗效;分析治疗前、末次随访(治疗后5年)椎间盘突出物体积变化,计算突出物体积吸收率,观察突出物吸收情况;分析JOA改善率与突出物吸收率之间关系。结果:71例患者完成随访,非手术治疗后3个月、6个月、1年、2年、5年JOA评分、SLRT、指地距与治疗前比较,差异有统计学意义(P0.05)。治疗后5年与6个月、治疗后5年与2年、治疗后2年与6个月JOA评分比较,差异无统计学意义(P0.05),其余各时间点两两比较,差异均有统计学意义(P0.05);治疗后5年与6个月、治疗后5年与2年、治疗后2年与6个月SLRT、指地距比较,差异亦无统计学意义(P0.05),其余各时间点两两比较,差异均有统计学意义(P0.05)。末次随访JOA改善率为(62.69±2.47)%,按照JOA评分评定疗效,结果优26例,良26例,可14例,差5例,优良率73.24%;突出物体积由起始的(1 981.73±588.72) mm3减少至(1 011.82±395.47) mm3,总体吸收率(45.65±2.83)%,突出物发生明显吸收24例,部分吸收26例,未吸收19例,增大2例。JOA改善率与突出物吸收率作Spearman秩相关分析,发现两者呈中等以上正相关(r=0.679,P0.001)。结论:非手术治疗破裂型腰椎间盘突出症可取得良好疗效,明确了破裂型腰椎间盘突出症的病情特点及预后转归,同时部分患者发生"重吸收"现象。

A 5-year follow-up study on non-surgical treatment of ruptured lumbar disc herniation

Objective: To investigate the short-term and mid-term efficacy with non-surgical treatment and to predict the long-term outcomes of ruptured lumbar disc herniation.Methods: From February 2011 to February 2014,75 patients with single-segment ruptured lumbar disc herniation treated by non-surgical therapy were selected for prospective study. There were 53 males and 22 females,aged from 18 to 58(35.62±9.96) years old. The course of disease was from 5 days to 6 months,with an average of (46.45±40.66) days. The lesions were located at L_3,4 in 4 cases,at L_4,5 in 29 cases,at L₅S₁ in 42 cases. Radiation pain in 46 cases on the left and 29 cases on the right. The JOA score,straight leg raising test angle and finger-to-ground distance were assessed pretreatment and at 3 months,6 months,1 year,2 years and 5 years after treatment. The improvement rate of JOA at the final follow-up(5 years after treatment) was calculated and the curative effect according to JOA score was evaluated;the volume change of protrusion before treatment and at the final follow-up (5 years after treatment) was analyzed,the volume absorption rate of protrusion was calculated and the absorption of protrusion was observed;the relationship between the improvement rate of JOA and the absorption rate of protrusion were analyzed.Results: Seventy-one patients were finally followed up at 5 years after non-surgical treatment. The JOA score,straight leg raising test angle and finger-to-ground distance at 3 months,6 months,1 year,2 years and 5 years after treatment were significantly improved(P<0.05). There was no significant difference in JOA scores between 5 years and 6 months after treatment,5 and 2 years after treatment,and 2 years and 6 months after treatment(P>0.05). There was significant difference in other time points(P<0.05). The results of the straight leg raising test angle and the finger-to-ground distance were similar to the JOA scores. The improvement rate of JOA score was (62.69±2.47)% at the final follow-up. According to JOA score,the results were excellent in 26 cases,good in 26 cases,fair in 14 cases,poor in 5 cases,and the excellent and good rate was 73.24%. The volume of protrusion decreased from(1 981.73±588.72) mm³ to(1 011.82±395.47) mm³,the total absorption rate was (45.65±2.83)%,the protrusion was obviously absorbed in 24 cases,partially absorbed in 26 cases,not absorbed in 19 cases,and increased in 2 cases. It was found that there was a positive correlation between improvement rate of JOA scores and protrusion absorption rate at 5 years after non-surgical treatment(r=0.679,P<0.001).Conclusion: Non-surgical treatment of ruptured lumbar disc herniation can achieve good results,clear the characteristics of the ruptured lumbar disc herniation and prognosis,and some patients have "reabsorption" phenomenon.