术后重症腰椎间盘炎治疗方法的比较

目的探讨重症腰椎间盘炎的有效、省时、经济的治疗方法。方法回顾分析1992年10月～2000年10月诊治的15例重症腰椎间盘炎患者的治疗过程,比较前路经腹膜后入路病变间隙残余椎间盘切除术和传统的保守治疗方法在疗效、住院时间、治疗费用方面的差异。结果经保守治疗组症状持续时间平均3.8个月(3～5个月),住院时间平均1.5个月(1～3个月),住院费用平均3.25万元(2～6万元);手术治疗组在术后3～5d严重腰痛明显缓解,不需再使用止痛剂,住院时间平均16.5d(14～23d),住院费用平均0.8万元(0.6～1.5万元)。两者比较差异有显著性意义(P<0.01)。结论对重症腰椎间盘炎患者采用传统的保守治疗方法疗效差、费用高、住院时间长;而采用前路经腹膜后病变间隙残余椎间盘切除术则能迅速解除症状、缩短住院时间、降低费用,是治疗重症腰椎间盘炎最为有效的手段。

Treatment of the severe postoperative discitis through the anterior debridement of the remnant disc

Objective To evaluate the results of anterior debridement of the remnant disc for the treatment of severe postoperative discitis. Methods A retrospective analysis of 15 cases of the severe postoperative discitis was made; their clinical courses, the duration of hospitalization, the cost and the duration of the symptoms were studied. Five cases were treated with conservative method, which included intravenous use of antibiotics for 1-1.5 months and strict bed rest for 3-5 months. Ten patients were operated on through the anterior lateral retroperitoneal approach to clear out the remained disc tissues, including the annuli fibrosis, the nucleus pulposus, and even the cartilage endplates. Postoperatively, antibiotics were administrated intravenously for 7-10 days. Results The mean symptomatic duration of 5 cases who underwent conservative treatment was 3.8 months (3-5 months). The mean hospital stay was 1.5 months (1-3 months).The average cost was 32 500 yuan (20 000-60 000 yuan). The patients felt depressed and had poor appetite and an unhappy mood. Whereas, the 10 patients who underwent the anterior debridement of the involved disc had remarkable improvement of their severe back pain only 3-5 days after surgery, and could turn in bed freely. They had good appetite, slept well and soon recovered to normal pscychological mood. The average hospital stay was 16.5 days(14-23 days), the average cost was 8 000 yuan(6 000-1 5000 yuan). The roentgenographic follow up showed the intervertebral fusion 2.5-3.5 months after surgery. Conclusion The surgery of the anterior remnant disc debridement has more advantages over the conservative treatment.The surgery relieves the symptoms in a short time; it is a most effective method of treatment.