CAJ | 학술논문

目的探讨开窗髓核摘除术治疗腰椎间盘突出症的不同病理分型的疗效.方法回顾性分析经后路椎板开窗髓核摘除术治疗98例腰椎间盘突出症患者,根据术中所见椎间盘突出的髓核形态及纤维环破损大小将其分为四型,并对各型进行术后3个月疗效观察,并进行统计学分析比较.结果术前术后JOA评分显示下腰背痛、腿痛和/或麻刺痛、步态、日常活动受限度及总分的改善各分型都有显著的统计学差异(P＜0.01);下腰背痛和直腿抬高试验,除Ⅰ型外,其它各型术前术后比较均有统计学差异(P＜0.01);感觉、运动及膀胱功能方面,除Ⅳ型外,其它各型术前术后比较均无统计学差异(P＞0.05).手术后,各型VAS评分显著低于术前(P＜0.01).根据SC标准,疗效优劣依次为Ⅳ型、Ⅱ型、Ⅲ型、Ⅰ型.结论腰椎间盘突出症患者在采用开窗髓核摘除术后患者的下腰背痛、步态、腿痛和/或麻刺痛及总分改善各分型等方面均较明显改善,有较好临床疗效.开窗髓核摘除术治疗腰椎间盘突出症的预后跟术前椎间盘的纤维环的完整性密切相关.
목적 탐토개창수핵적제술치료요추간반돌출증적불동병리분형적료효.방법 회고성분석경후로추판개창수핵적제술치료98례요추간반돌출증환자,근거술중소견추간반돌출적수핵형태급섬유배파손대소장기분위사형,병대각형진행술후3개월료효관찰,병진행통계학분석비교.결과 술전술후JOA평분현시하요배통、퇴통화/혹마자통、보태、일상활동수한도급총분적개선각분형도유현저적통계학차이(P＜0.01);하요배통화직퇴태고시험,제Ⅰ형외,기타각형술전술후비교균유통계학차이(P＜0.01);감각、운동급방광공능방면,제Ⅳ형외,기타각형술전술후비교균무통계학차이(P＞0.05).수술후,각형VAS평분현저저우술전(P＜0.01).근거SC표준,료효우렬의차위Ⅳ형、Ⅱ형、Ⅲ형、Ⅰ형.결론 요추간반돌출증환자재채용개창수핵적제술후환자적하요배통、보태、퇴통화/혹마자통급총분개선각분형등방면균교명현개선,유교호림상료효.개창수핵적제술치료요추간반돌출증적예후근술전추간반적섬유배적완정성밀절상관.
Objective To explore the effect of discectomy for different pathological typings of lumbar disc herniations.Methods 98 patients with lumbar disc herniations treated by discectomy were retrospectively analyzed.They were divided into four types by the nucleus pulposus shape and the size of fibrous rings breakage in the intraoperative findings,and to explore the effect of every type after 3 months.All results were analyzed statistically.Results Preoperative and postoperative JOA scores showed that backache,skelalgia,gait,daily activity limitation and the total scores were significantly different in all types (P ＜ 0.01).Except for type Ⅰ,backache and straight-leg raising test got significant differences in all types (P ＜ 0.01).Except for type Ⅳ,sensory,motility and bladder dysfunction were not significantly different in all types (P ＞0.05).Postoperative VAS scores of each type were significantly lower than preoperative VAS scores (P ＜ 0.01).The therapeutic effects were ranked by SC criterion such as type Ⅳ ＞type]Ⅱ ＞type Ⅲ ＞type Ⅰ.Conclusion After fenestration discectomy,backache,gait,skelalgia and the total scores of patients with lumbar disc herniation significantly improved,with good clinical effect.Prognosis was related to preoperative completeness of annulus fibrosus of intervertebral disc.