中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2008年
5期
383-386
,共4页
田禾%屈建华%田征%王翀%韩智君
田禾%屈建華%田徵%王翀%韓智君
전화%굴건화%전정%왕충%한지군
椎间盘移位%内固定器%治疗结果
椎間盤移位%內固定器%治療結果
추간반이위%내고정기%치료결과
Intervertebral disk displacement%Internal fixators%Treatment outcome
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.
目的 探討4種不同方法治療腰椎間盤突齣癥的中長期療效.方法 對440例腰椎間盤突齣癥患者行後路開窗減壓髓覈摘除(A組,178例)、半椎闆切除(B組,122例)、全椎闆切除(C組,66例)及上述3種術式加後路椎弓根螺釘繫統內固定(D組,74例)治療.術後隨訪30～66箇月,平均49箇月.穫得隨訪病例,男245例,年齡19～72歲,平均(43.36±11.64)歲,病程3 d～18年;女195例,年齡20～76歲,平均(43.78±12.09)歲,病程7 d～20年.對臨床資料進行迴顧性分析,按照Oswestry 功能障礙指數(Oswestry disability index,ODI)設計問捲隨訪,對不同術式腰椎間盤突齣癥臨床效果進行評分併行統計學分析.結果 4種術式總體優良率分彆為88.76%、83.61%、77.27%、90.54%,D組與A、B組比較療效差異無統計學意義(P＞0.05),D組與C組比較療效差異有統計學意義(P＜0.05);A、B、C、D組單節段優良率分彆為89.93%、85.58%、78.57%與90.77%,雙節段優良率分彆為81.48%、76.47%、70.00%與87.50%,內固定組與非內固定組療效差異均無統計學意義(P＞0.05).結論 傳統經典手術加後路內固定為腰椎間盤突齣癥手術徹底減壓融閤創造良好條件,但無論是單節段或雙節段病變,加後路內固定都不能顯著提高臨床療效.傳統經典手術仍是治療腰椎間盤突齣癥的安全、有效方法.
목적 탐토4충불동방법치료요추간반돌출증적중장기료효.방법 대440례요추간반돌출증환자행후로개창감압수핵적제(A조,178례)、반추판절제(B조,122례)、전추판절제(C조,66례)급상술3충술식가후로추궁근라정계통내고정(D조,74례)치료.술후수방30～66개월,평균49개월.획득수방병례,남245례,년령19～72세,평균(43.36±11.64)세,병정3 d～18년;녀195례,년령20～76세,평균(43.78±12.09)세,병정7 d～20년.대림상자료진행회고성분석,안조Oswestry 공능장애지수(Oswestry disability index,ODI)설계문권수방,대불동술식요추간반돌출증림상효과진행평분병행통계학분석.결과 4충술식총체우량솔분별위88.76%、83.61%、77.27%、90.54%,D조여A、B조비교료효차이무통계학의의(P＞0.05),D조여C조비교료효차이유통계학의의(P＜0.05);A、B、C、D조단절단우량솔분별위89.93%、85.58%、78.57%여90.77%,쌍절단우량솔분별위81.48%、76.47%、70.00%여87.50%,내고정조여비내고정조료효차이균무통계학의의(P＞0.05).결론 전통경전수술가후로내고정위요추간반돌출증수술철저감압융합창조량호조건,단무론시단절단혹쌍절단병변,가후로내고정도불능현저제고림상료효.전통경전수술잉시치료요추간반돌출증적안전、유효방법.
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.
