腰椎间盘突出症两种术式的对比分析
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摘要
目的：观察腰椎间盘突出症患者单纯髓核摘除术与椎间融合术的术后疗效。方法：回顾性研究本院2007年1月～2010年12月期间接受单纯髓核摘除术与椎间融合术治疗的50岁至65岁腰椎间盘突出症患者的临床资料，除外高位腰椎间盘突出症、多节段腰椎间盘突出症、合并腰椎管狭窄、合并腰椎不稳、合并腰椎滑脱、极外侧型腰椎间盘突出症患者，采用电话随访、信件随访及门诊复查随访相结合的方式，最终获得随访且临床资料完整的患者共40例，其中单纯髓核摘除术组（单摘组）19例，椎间融合术组21例，记录两组患者的手术时间、出血量、住院天数及治疗费用；采用Oswestry残障指数（ODI）、JOA下腰痛评分、下腰痛疗效结果评分（LBOS）、Roland-Morris功能障碍问卷(RDQ)评价两组患者临床疗效。测量患者术前及随访时病变椎间隙高度比值及弓顶距离。
结果：随访24～70个月，平均46.6个月。单纯髓核摘除术组在手术时间、出血量、治疗费用方面均有明显优势（p＜0.05）。两组患者术后三个月及末次随访时弓顶距均较术前改善，且有统计学意义（p＜0.05）。单纯髓核摘除术组和椎间融合术组间比较弓顶距各时间点均无统计学意义（p＞0.05）。椎间融合术组患者术后三个月及末次随访时椎间高度与术前比较无统计学差异（p＞0.05）；单纯髓核摘除术组患者术后三个月椎间高度较术前无统计学差异（p＞0.05），末次随访椎间高度比值较术前降低，且有统计学差异（p＜0.05）；两手术组之间比较显示术后三个月和末次随访时椎间融合术组椎间高度比值均大于单纯髓核摘除术组（p＜0.05）。两组患者术前、术后三个月及末次随访时ODI评分、LBOS评分、JOA评分、RDQ评分均较术前明显改善。两组间比较各项评分无统计学差异（p＞0.05）
结论：
1、单纯髓核摘除术和椎间融合术均是治疗成人腰椎间盘突出症的有效手术方式。
2、椎间融合术组手术时间长，出血量较多，医疗费用大，但是利于获得腰椎即刻稳定，对腰椎间高度的维持值得肯定。3、单纯髓核摘除术以较小的创伤和较少的费用可以取得与椎间融合术基本对等的手术效果，同时避免了内置物相关风险，更适用于50到65岁之间的单阶段单纯腰椎间盘突出症。
Objective: To Observe the efficacy of simple discectomy and interbody fusion in thetreatment of patients with lumbar disc herniation.
Methods: We did a retrospective study of lumbar disc herniation patients with simplediscectomy and interbody fusion in our hospital from January2007to December2010,aged from50to65years old, except the upper lumbar disc herniation, combinedmulti-segmental lumbar disc herniation, lumbar spinal stenosis, lumbar not steady, withlumbar spondylolisthesis, extreme lateral lumbar disc herniation.We finally obtain40casesof follow-up patients and their clinical data by telephone follow-up, e-mail follow-up andoutpatient follow-up, including simple nucleus pulposus removed surgery group (singlepick group)19cases, lumbar interbody fusion group21cases, recording operation time,bleeding, hospitalization days and cost of treatment; evaluating clinical curative effect oftwo groups with the Oswestry Disability Index, ODI:0~100%, LBOS, JOA low back painscore and Roland-Morris Disability Questionnaire(RDQ). Measured preoperatively and atfollow-up disc space height ratio and lesion bow top distance.
Results: We followed up for24~70months, average46.6months. Simple discectomygroup has obvious advantage (p<0.05) in the operation time, bleeding volume, the cost oftreatment. Arch roof of two groups were improved after three months and final follow-upafter operation, and there was statistical significance (p <0.05). Bow crest interbody fusionfrom each time point had no statistical significance between the two groups (p>0.05).Height between discs compared with those before operation showed no significantdifference (p>0.05) in interbody fusion group after3months and final follow-up; Heightbetween discs compared with those before operation showed no significant difference (p>0.05) in simple discectomy group after3months,but had significant difference (p <0.05)in final follow-up; comparison of height between discs between the two groups after threemonths and final follow-up, interbody fusion group was better than simple discectomygroup, and the difference had statistical significance (p<0.05). ODI score, LBOS score, JOA score, RDQ score of two groups before operation, three months after operation and atfinal follow-up were significantly improved compared with preoperative. There is nosignificant difference in efficacy between the two groups (p>0.05)
Conclusion:
1, Simple discectomy and interbody fusion both are effective operations for the treatmentof adult lumbar disc herniation.
2,Interbody fusion group had longer operation time, bleeding more and costing more, butwas beneficial to obtain immediate stability of lumbar spine and positively maintainlumbar intervertebral height.
3, Simple discectomy with less trauma and less cost can obtain the basicly equivalentoperation effect of interbody fusion, while avoiding the risks associated with built-inobjects, more suitable for those single stage single lumbar disc herniation patiencesbetween50to65years old.
结果：随访24～70个月，平均46.6个月。单纯髓核摘除术组在手术时间、出血量、治疗费用方面均有明显优势（p＜0.05）。两组患者术后三个月及末次随访时弓顶距均较术前改善，且有统计学意义（p＜0.05）。单纯髓核摘除术组和椎间融合术组间比较弓顶距各时间点均无统计学意义（p＞0.05）。椎间融合术组患者术后三个月及末次随访时椎间高度与术前比较无统计学差异（p＞0.05）；单纯髓核摘除术组患者术后三个月椎间高度较术前无统计学差异（p＞0.05），末次随访椎间高度比值较术前降低，且有统计学差异（p＜0.05）；两手术组之间比较显示术后三个月和末次随访时椎间融合术组椎间高度比值均大于单纯髓核摘除术组（p＜0.05）。两组患者术前、术后三个月及末次随访时ODI评分、LBOS评分、JOA评分、RDQ评分均较术前明显改善。两组间比较各项评分无统计学差异（p＞0.05）
结论：
1、单纯髓核摘除术和椎间融合术均是治疗成人腰椎间盘突出症的有效手术方式。
2、椎间融合术组手术时间长，出血量较多，医疗费用大，但是利于获得腰椎即刻稳定，对腰椎间高度的维持值得肯定。3、单纯髓核摘除术以较小的创伤和较少的费用可以取得与椎间融合术基本对等的手术效果，同时避免了内置物相关风险，更适用于50到65岁之间的单阶段单纯腰椎间盘突出症。
Objective: To Observe the efficacy of simple discectomy and interbody fusion in thetreatment of patients with lumbar disc herniation.
Methods: We did a retrospective study of lumbar disc herniation patients with simplediscectomy and interbody fusion in our hospital from January2007to December2010,aged from50to65years old, except the upper lumbar disc herniation, combinedmulti-segmental lumbar disc herniation, lumbar spinal stenosis, lumbar not steady, withlumbar spondylolisthesis, extreme lateral lumbar disc herniation.We finally obtain40casesof follow-up patients and their clinical data by telephone follow-up, e-mail follow-up andoutpatient follow-up, including simple nucleus pulposus removed surgery group (singlepick group)19cases, lumbar interbody fusion group21cases, recording operation time,bleeding, hospitalization days and cost of treatment; evaluating clinical curative effect oftwo groups with the Oswestry Disability Index, ODI:0~100%, LBOS, JOA low back painscore and Roland-Morris Disability Questionnaire(RDQ). Measured preoperatively and atfollow-up disc space height ratio and lesion bow top distance.
Results: We followed up for24~70months, average46.6months. Simple discectomygroup has obvious advantage (p<0.05) in the operation time, bleeding volume, the cost oftreatment. Arch roof of two groups were improved after three months and final follow-upafter operation, and there was statistical significance (p <0.05). Bow crest interbody fusionfrom each time point had no statistical significance between the two groups (p>0.05).Height between discs compared with those before operation showed no significantdifference (p>0.05) in interbody fusion group after3months and final follow-up; Heightbetween discs compared with those before operation showed no significant difference (p>0.05) in simple discectomy group after3months,but had significant difference (p <0.05)in final follow-up; comparison of height between discs between the two groups after threemonths and final follow-up, interbody fusion group was better than simple discectomygroup, and the difference had statistical significance (p<0.05). ODI score, LBOS score, JOA score, RDQ score of two groups before operation, three months after operation and atfinal follow-up were significantly improved compared with preoperative. There is nosignificant difference in efficacy between the two groups (p>0.05)
Conclusion:
1, Simple discectomy and interbody fusion both are effective operations for the treatmentof adult lumbar disc herniation.
2,Interbody fusion group had longer operation time, bleeding more and costing more, butwas beneficial to obtain immediate stability of lumbar spine and positively maintainlumbar intervertebral height.
3, Simple discectomy with less trauma and less cost can obtain the basicly equivalentoperation effect of interbody fusion, while avoiding the risks associated with built-inobjects, more suitable for those single stage single lumbar disc herniation patiencesbetween50to65years old.
引文
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2. Murphy, RW. Nerve root and spinal nerves in degenerative diskdisease.Clin Orthop,1977,129:46
3. Saal JA. Natural history and nonoperative treatment of lumbar discherniation.Spine.1996;21:2‐9.
4.周秉文;胡有谷;孙进修腰椎间盘突出症的分型及术称商榷1988
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