CAJ | 학술논문

背景：腰椎间盘突出症是引发腰腿痛最常见的原因，腰椎间盘突出症修复方式的选择及各种治疗方法的预后疗效是目前研究的焦点。 　　目的：总结腰椎间盘突出症修复治疗的研究现状及进展。 　　方法：应用计算机检索CNKI中国知网数据库及PubMed数据库中1990年1月至2014年1月关于腰椎间盘突出症手术治疗的文章，在标题和关键词中以“腰椎间盘突出症、手术治疗”或“LumbarHerniatedDisc，SurgicalTherapy”为检索词进行检索，最终纳入61篇文献进行综述。 　　结果与结论：目前腰椎间盘突出症的外科治疗方式众多，主要有经典腰椎间盘突出髓核摘除、腰椎植骨融合、经皮椎间盘髓核切除、经皮激光椎间盘减压、经皮化学髓核溶解、人工髓核置换和人工腰椎间盘置换等治疗方式，文章对各种外科治疗方法、适应证、疗效及预后评估进行了回顾，并对腰椎间盘突出症修复治疗的新进展进行了总结。结果发现，后路腰椎间盘突出髓核摘除仍是目前应用最广泛且最成熟的修复方式，但此方法并发症较多，对患者的创伤较大；微创治疗腰椎间盘突出症有创伤小、并发症少和恢复快等优特点，但此术式限制较多，操作难度相对较高，仍需要进一步改善和发展。硬性植入物的替代是新近发展出来的治疗方法，对于重症腰椎间盘突出有较好的短期疗效，但是该术式的远期预后仍存在很多问题，且并发症较多，需要在替代材料及修复方式进行进一步的研究与发展，并开展大规模临床试验后推广使用。
배경：요추간반돌출증시인발요퇴통최상견적원인，요추간반돌출증수복방식적선택급각충치료방법적예후료효시목전연구적초점。 　　목적：총결요추간반돌출증수복치료적연구현상급진전。 　　방법：응용계산궤검색CNKI중국지망수거고급PubMed수거고중1990년1월지2014년1월관우요추간반돌출증수술치료적문장，재표제화관건사중이“요추간반돌출증、수술치료”혹“LumbarHerniatedDisc，SurgicalTherapy”위검색사진행검색，최종납입61편문헌진행종술。 　　결과여결론：목전요추간반돌출증적외과치료방식음다，주요유경전요추간반돌출수핵적제、요추식골융합、경피추간반수핵절제、경피격광추간반감압、경피화학수핵용해、인공수핵치환화인공요추간반치환등치료방식，문장대각충외과치료방법、괄응증、료효급예후평고진행료회고，병대요추간반돌출증수복치료적신진전진행료총결。결과발현，후로요추간반돌출수핵적제잉시목전응용최엄범차최성숙적수복방식，단차방법병발증교다，대환자적창상교대；미창치료요추간반돌출증유창상소、병발증소화회복쾌등우특점，단차술식한제교다，조작난도상대교고，잉수요진일보개선화발전。경성식입물적체대시신근발전출래적치료방법，대우중증요추간반돌출유교호적단기료효，단시해술식적원기예후잉존재흔다문제，차병발증교다，수요재체대재료급수복방식진행진일보적연구여발전，병개전대규모림상시험후추엄사용。
BACKGROUND:Orthopedic lumbar disc herniation is a common and frequently-occurring disease which causes low back pain. Selection of surgical therapy and postoperation efficacy on lumbar disc herniation are hot focus in present study. OBJECTIVE:To summarize current research and progress on surgical treatment of lumbar disc herniation. METHODS:The databases of PubMed and China National Knowledge Infrastructure were searched from January 1990 to January 2014 for articles on surgical treatment of lumbar disc herniation. Keywords were“Lumbar Herniated Disc;Surgical Therapy”in Chinese and English. Final y, 61 literatures were chosen. RESULTS and CONCLUSION:There are a variety of surgical treatments for lumbar disc herniation at present, including traditional surgical procedures, lumbar fusion, percutaneous lumbar discectomy, percutaneous laser decompression, chemonucleolysis, artificial nucleus replacement, and artificial lumbar disc replacement. This study reviewed surgical methods, indication, efficacy and prognosis, and summarized the new progression of repair and therapy of lumbar disc herniation. Results found that posterior lumbar discectomy remains the most widely used and the most mature procedure, but this method has many complications and induces great trauma. Minimal y invasive treatment for lumbar disc herniation is considered to be the future direction for smal surgical trauma, less complications and fast recovery, but the surgical indications are narrow and the operation is relatively difficult, so this method stil needs more improvement and development. Lumbar disc replacement is a new treatment for lumbar disc herniation which has a good short-term postoperative fol ow-up, but the long-term prognosis stil has many problems and complications. Lumbar disc replacement needs more research and development in alternative materials and surgical approach, and should be widely applied after large-sample tests.