伴有“自溶”现象的腰椎椎间盘突出症的治疗探讨

目的 探讨对伴有“自溶”现象的腰椎椎间盘突出症的治疗策略。 方法 回顾2006年1月~2011年12月本院收治的腰椎椎间盘突出症患者34例，所有患者比较首次发病与入院前腰椎MRI检查发现均有突出椎间盘缩小的影像学表现。对其中15例行腰后路减压椎间植骨内固定术或髓核摘除术；19例采用卧床休息、腰围固定以及脱水、消炎镇痛等非手术治疗。采用Oswestry功能障碍指数（Oswestry disability index, ODI）、疼痛视觉模拟量表（visual analogue scale, VAS）评分及影像学检查评价治疗效果。 结果 手术组15例，手术切口均一期愈合，随访2~16个月，平均12.3个月。术前ODI为42.8±4.25，末次随访时为12.5±1.26,与术前比较差异有统计学意义（P＜0.01）。VAS评分术前为7.13±1.24分，末次随访时为1.45±0.86分, 与术前比较差异有统计学意义（P＜0.01）。非手术治疗组19例，治疗前ODI为27.9±3.61，末次随访时为10.5±6.4，治疗6个月后复查腰椎MRI平扫提示突出椎间盘完全消失者4例，部分消失者9例，无明显变化者6例。 结论 对于伴有“自溶”现象的腰椎椎间盘突出症患者应根据影像学及临床表现采用相应的治疗方法，可获得较满意的临床疗效。

Clinical protocol for lumbar disc herniation combined with herniated disc resorption

Objective To discuss the clinical protocol for lumbar disc herniation combined with herniated disc resorption. Methods From November 2006 to December 2011,34 patients suffering from lumbar disc herniation （LDH） combined with spontaneous regression of herniated disc were reviewed. These patients were classified into surgical treatment group and conservative treatment group according to the progression of patient＇ s symptoms before treatment. The Oswestry disability index （ODI） and visual analogue scale （VAS） score were used to assess the outcome of treatment. Results The DOI of 15 patients in surgical treatment group improved from 42.8 ±4. 25 to 12. 5 ± 1.26 at the final follow-up（P 〈0. 01 ）, and the VAS scores decreased from 7.13± 1.24to 1.45 ± 0. 86 at the final follow-up （P 〈 0.01 ）. The DOI of 19 patients in conservative treatment group improved from 18.9 ± 3.61 to 10. 5 ± 6.4 at the final follow-up. According to MRI scans of conservative treatment group at the final follow-up, 4 cases presented an entire disappearance of the herniated disc; part disappearance in 9 cases; no change in 6 cases. Conclusion LDH patients with herniated disc resorption can be treated by rational therapy according to the imageological examination and clinical manifestations.