CAJ | 학술논문

目的分析并判断伴腰椎退行性终板Modic变化并以腰腿痛为主诉的腰椎间盘突出症的术式选择及其疗效差异.方法回顾性地分析了自2005年1月至2008年1月采用单纯髓核摘除术或减压伴椎问融合术治疗的30例伴有腰椎退行性终板Medic变化的单节段腰椎间盘突出症患者.男18例,女12例,平均年龄38.5岁(26～53岁),平均随访1年9个月(4～3年4个月).结果单纯髓核摘除术组共15例,术前和最后随访时的JOA、下腰痛及下肢根性痛的VAS的平均值分别为13.2(5～17)、6.8(4～10)、4.8(1～8)和19.8(14～24)、4.8(2～10)、1.2(0～6);手术前后JOA评分的平均改善率为41.9%;手术前后下肢根性痛的VAS平均差值为3.7;术后有5例患者的下腰痛加剧.Medic Ⅰ、Ⅱ和Ⅰ/Ⅱ混和型分别占5、9、1例.减压伴椎问融合术组共15例,术前和最后随访时的JOA、下腰痛及下肢根性痛的VAS的平均值分别为12.9(5～17)、7.0(4～10)、4.9(1～8)和22.6(19～28)、2.8(2～8)、1.3(0～6);手术前后JOA评分的平均改善率为63.4%;手术前后下腰痛及下肢根性痛的VAS平均差值分别为4.3和3.6.Medic Ⅰ、Ⅱ和Ⅰ/Ⅱ混和型分别占6、8、1例.减压伴椎间融合术组在术后的下腰痛VAS和日本骨科学会下腰痛JOA评分及其改善率上优于单纯髓核摘除术组.结论对于伴有腰椎退行性终板Medic变化且以下肢根性痛和下腰痛为共同主诉的腰椎间盘突出症患者,如果术前下腰痛的程度大于下肢根性痛,采用单纯髓核摘除术或减压伴椎问融合术尽管均能显著地改善下肢根性痛,但前者在改善下腰痛及功能评分上不及后者,因此采用腰椎减压伴融合术是较佳的选择.
목적 분석병판단반요추퇴행성종판Modic변화병이요퇴통위주소적요추간반돌출증적술식선택급기료효차이.방법 회고성지분석료자2005년1월지2008년1월채용단순수핵적제술혹감압반추문융합술치료적30례반유요추퇴행성종판Medic변화적단절단요추간반돌출증환자.남18례,녀12례,평균년령38.5세(26～53세),평균수방1년9개월(4～3년4개월).결과 단순수핵적제술조공15례,술전화최후수방시적JOA、하요통급하지근성통적VAS적평균치분별위13.2(5～17)、6.8(4～10)、4.8(1～8)화19.8(14～24)、4.8(2～10)、1.2(0～6);수술전후JOA평분적평균개선솔위41.9%;수술전후하지근성통적VAS평균차치위3.7;술후유5례환자적하요통가극.Medic Ⅰ、Ⅱ화Ⅰ/Ⅱ혼화형분별점5、9、1례.감압반추문융합술조공15례,술전화최후수방시적JOA、하요통급하지근성통적VAS적평균치분별위12.9(5～17)、7.0(4～10)、4.9(1～8)화22.6(19～28)、2.8(2～8)、1.3(0～6);수술전후JOA평분적평균개선솔위63.4%;수술전후하요통급하지근성통적VAS평균차치분별위4.3화3.6.Medic Ⅰ、Ⅱ화Ⅰ/Ⅱ혼화형분별점6、8、1례.감압반추간융합술조재술후적하요통VAS화일본골과학회하요통JOA평분급기개선솔상우우단순수핵적제술조.결론 대우반유요추퇴행성종판Medic변화차이하지근성통화하요통위공동주소적요추간반돌출증환자,여과술전하요통적정도대우하지근성통,채용단순수핵적제술혹감압반추문융합술진관균능현저지개선하지근성통,단전자재개선하요통급공능평분상불급후자,인차채용요추감압반융합술시교가적선택.
Objective To analyze the selection of surgical methods for lumbar disc herniation with low back and leg pain and degenerative lumbar Medic endplate changes and their different postoperative therapeutic effects. Methods All 30 cases of single segment lumbar disc herniation accompanied by Modie endplate changes operated at our hospital using simple discectomy or decompressions with interbedy fusion from January 2005 to January 2008 were retrospectively identified. There were 18 males and 12 females with an average age of 38. 5 years old ( 26-53 years old) and an average follow-up of 21 months (4-40 months). Results Discectomy alone group included 15 cases. The average score of Japanese Orthopedics Association (JOA) and visual analysis scale (VAS) of low back pain and lower extremity radicular pain at the preoperative and final follow-up time was 13.2 (5-17 ), 6.8 (4-10), 4.8(1-8) and 19.8(14-24), 4.8(2-10), 1.2(0-6) respectively. The average improvement rate of JOA was 41.9%. The difference of VAS of lower extremity radieular pain between pre and post-operation was 3.7 on average.Among these 15 cases, Medic I, Ⅱ and Ⅰ/Ⅱ mixed-type was 5, 9, and 1 respectively. Decompression with interbody fusion group included 15 eases. VAS of low back pain and lower extremity radicular pain at the preoperative and final follow-up time was 12.9(5-17),7.0(4-10),4.9(1-8) and 22.6(19-28),2. 8 (2-8 ) and 1.3 (0-6) respectively. The average improvement rate of JOA was 63.4%. The differences of VAS of lower extremity radicular pain and low back pain between pre and post-operation were 4. 3 and 3.6 on average respectively. Among these cases, Medic Ⅰ,Ⅱ and Ⅰ/Ⅱ mixed-type was 6, 8,and 1 respectively. Comparing the VAS of low back pain, JOA average score and the improvement rate of JOA score of two groups at pre-operation and post-operation, statistical analysis showed that decompression with interbedy fusion group was superior to simple diseectomy group. Conclusion For lumbar disc herniation with degenerative Medic endplate changes, who suffered more from low back pain than lower extremity radicular pain, discectomy alone and decompression with interbody fusion could both improve the degree of lower extremity radicular pain, but discectomy alone is less likely to improve the degree of low back pain and function score than the latter. So the maneuver of lumbar decompression with fusion is a better choice.