经皮激光气化减压术治疗腰椎问盘突出症后椎问隙高度改变和中长期临床疗效

目的观察经皮激光气化减压术（pereutaneous laser disc decompression，PLDD）治疗腰椎间盘突出症后椎间隙高度的变化和中长期临床疗效。方法腰椎间盘突出症患者（L4-5）256例，行PLDD治疗，激光输出功率10w，脉冲时间1s，脉冲间隔时间1s。术后随访6、18和60个月，比较术前、术后手术节段椎间隙高度（intervertebral height，IH）变化、手术前后疼痛的VAS评分、Oswestry功能障碍指数（Oswestry Disability Index，ODI）和改良Menab疗效评分法，以评估临床疗效。结果术前、术后VAS疼痛评分及ODI评分较术前明显缓解（P〈0．05）；术前、术后手术节段椎间隙高度比较差异无显著性（P〉0．05）；术后18和60个月满意率（Menab评分优良者）分别为90．3％和86．2％。结论PLDD治疗腰椎间盘突出症远期效果好，同时可有效维持椎间隙高度。

Medium and Long-Term Clinical Observation on Intervertebral Height Changes after and Clinical Efficacy of Percutaneous Laser Disk Decompression on Lum- bar Intervertebral Disc Herniation

Objective To evaluate the long-term clinical efficacy of pereutaneous laser decompression （PLDD） in treatinglumbar disc herniation. Methods Medical follow-up were performed for 256 patients （ L4 - 5 ） of lumbar disc herniation who had received PLDD treatment in our hospital from April 2003 to July 2008. The after-operation follow-up period averaged 0. 5-5 years. The intervertebral heights （IH） before the operation and 0. 5, 1.5 and 5 years after the operation, the leg pain VAS scores and Oswestry Disability Indexes before andafter the operation were cothpared, and the therapeutic effect was evaluated with Mcnab efficacy evaluation method. Results Both the postoperative leg pain VAS score and ODI score were significantly lower than the preoperative scores （P 〈 0. 05）. The difference between preoperative intervertebral height of surgical segment and postoperative height was not statistically significant （P 〉 0. 05 ）. The satisfaction rates （with high Mcnabscores） obtained in 18 month＇s follow-up and 60 months＇follow up were 90. 3% and 86. 3% respectively.