不同术式治疗腰椎间盘突出症的中长期疗效分析

目的 探讨4种不同方法治疗腰椎间盘突出症的中长期疗效.方法 对440例腰椎间盘突出症患者行后路开窗减压髓核摘除(A组,178例)、半椎板切除(B组,122例)、全椎板切除(C组,66例)及上述3种术式加后路椎弓根螺钉系统内固定(D组,74例)治疗.术后随访30～66个月,平均49个月.获得随访病例,男245例,年龄19～72岁,平均(43.36±11.64)岁,病程3 d～18年;女195例,年龄20～76岁,平均(43.78±12.09)岁,病程7 d～20年.对临床资料进行回顾性分析,按照Oswestry 功能障碍指数(Oswestry disability index,ODI)设计问卷随访,对不同术式腰椎间盘突出症临床效果进行评分并行统计学分析.结果 4种术式总体优良率分别为88.76%、83.61%、77.27%、90.54%,D组与A、B组比较疗效差异无统计学意义(P＞0.05),D组与C组比较疗效差异有统计学意义(P＜0.05);A、B、C、D组单节段优良率分别为89.93%、85.58%、78.57%与90.77%,双节段优良率分别为81.48%、76.47%、70.00%与87.50%,内固定组与非内固定组疗效差异均无统计学意义(P＞0.05).结论 传统经典手术加后路内固定为腰椎间盘突出症手术彻底减压融合创造良好条件,但无论是单节段或双节段病变,加后路内固定都不能显著提高临床疗效.传统经典手术仍是治疗腰椎间盘突出症的安全、有效方法.

The analysis of middle-term and long-term therapeutic outcomes of the treatment of lumbar disc herniation with different operations

Objective To evaluate the middle-term and long-term therapeutic effect of conventional discectomy and conventional discectomy with posterior internal fixators to treat lumbar disc herniation.Methods From May 2002 to May 2005, a total of 440 patients with lumbar disc herniation were involved in this study.There were 245 males,with the mean age of(43.36±11.64) years,ranged from 19 to 72 years, and 195 females,with the mean age of(43.78±12.09)years,ranged from 20 to 76 years.All patients were treated with four surgical methods:vertebral plate windowing discectomy in 178 cases(group A),hemiinterbral plate discectomy in 122 cases(group B),holovertebral plate discectomy in 66 cases(group C)and all of these discectomy with internal fixators in 74 cases(group D).All patients were followed up 30-66 months,with average 49 months.The clinical results of different operations were evaluated according to Oswestry disability index(ODI) method and compared between the four groups.Results The excellent and good rates of the four groups were 88.76%, 83.61%, 77.27% and 90.54% respectively.There was no differences between group D and A,B(P＞0.05),and the difference between group D and C was statistically significant (P＜0.05).The excellent and good rates of four groups in single segment were 89.93%, 85.58%, 78.57% and 90.77% respectively,while in double segments were 81.48%,76.47%,70.00% and 87.50% respectively.There were no differences between group D and A,B,C(P＞0.05).conclusion The conventional discectomy with posterior internal fixators place a good ground for posterior decompression and fusion of lumbar disc herniation,either single segment or double segments the curative effect can not be improved with posterior internal fixators.The conventional discectomy is still safe and effective method to treat lumbar disc herniation.