CAJ | 학술논문

目的观察后路硬脊膜切开椎间盘摘除术治疗单间隙高位腰椎间盘突出症的临床疗效.方法通过治疗单间隙高位腰椎间盘突出症患者35例,腰2～3间隙13例,腰3～4间隙22例;共分为两组,其中A组患者16例,行后路硬脊膜切开椎间盘摘除后外侧植骨融合术;B组患者19例,行侧后方椎间盘摘除椎间融合内固定术,对比两组术中出血量和手术时间,术后平均随访2年4个月,并行日本整形外科协会(JOA)评分和功能障碍指数(ODI)评估.结果 A组患者出血量为150 ～340 ml,平均253 ml;B组患者出血量为320～ 670 ml,平均478 ml.A组患者手术时间为75 ～125 min,平均93 min;B组患者手术时间为105～ 165 min,平均137 min.A组患者术前JOA评分为(10.30±2.27)分,ODI为(54.31±11.07)％,随访期末JOA评分为(24.10±1.26)分,ODI为(18.27±5.81)％,术前与随访期末比较差异有统计学意义(P＜0.05);B组患者术前JOA评分为(10.60±2.33)分,ODI为(53.93±10.46)％,随访期末JOA评分为(24.50±1.25)分,ODI为(18.02±5.78)％,术前与随访期末比较差异有统计学意义(P＜0.05);两组间各随访期比较差异无统计学意义(P＞0.05).结论经后路硬脊膜切开的方法治疗高位腰椎间盘突出症,术后患者也能达到满意的临床效果.
목적 관찰후로경척막절개추간반적제술치료단간극고위요추간반돌출증적림상료효.방법 통과치료단간극고위요추간반돌출증환자35례,요2～3간극13례,요3～4간극22례;공분위량조,기중A조환자16례,행후로경척막절개추간반적제후외측식골융합술;B조환자19례,행측후방추간반적제추간융합내고정술,대비량조술중출혈량화수술시간,술후평균수방2년4개월,병행일본정형외과협회(JOA)평분화공능장애지수(ODI)평고.결과 A조환자출혈량위150 ～340 ml,평균253 ml;B조환자출혈량위320～ 670 ml,평균478 ml.A조환자수술시간위75 ～125 min,평균93 min;B조환자수술시간위105～ 165 min,평균137 min.A조환자술전JOA평분위(10.30±2.27)분,ODI위(54.31±11.07)％,수방기말JOA평분위(24.10±1.26)분,ODI위(18.27±5.81)％,술전여수방기말비교차이유통계학의의(P＜0.05);B조환자술전JOA평분위(10.60±2.33)분,ODI위(53.93±10.46)％,수방기말JOA평분위(24.50±1.25)분,ODI위(18.02±5.78)％,술전여수방기말비교차이유통계학의의(P＜0.05);량조간각수방기비교차이무통계학의의(P＞0.05).결론 경후로경척막절개적방법치료고위요추간반돌출증,술후환자야능체도만의적림상효과.
Objective To study clinical efficacy of posterior dural incision and discectomy for single gap upper lumbar disc herniation.Methods There were 35 cases of single gap upper lumbar disc herniation,including 13 cases of lumbar 2-3,and 22 cases of lumbar 3-4.All patients were divided into two groups.Sixty cases were subjected to posterior dural incision and discectomy,followed by posterolateral fusion surgery (group A),and 19 cases to discectomy,followed by intervertebral fusion and internal fixation (group B).Blood loss and operative time during operation were observed.During the postoperative average follow-up period of 2 years and 4 months,the Japanese Orthopaedic Association (JOA) score and oswestry disability index (ODI) were assessed.Results The amount of blood loss during operation in group A and group B was 150-340 ml (mean 253 ml) and 320-670 ml (478 ml) respectively.The operative time in group A and group B was 75-125 min (mean 93 min) and 105-165 min (mean 137 min).There were significant differences in JOA score (10.30 ±2.27 vs.24.10 ± 1.26) score and ODI [(54.31 ± 11.07)％vs.(18.27 ± 5.81) ％] before operation and after the final follow-up in group A (P ＜ 0.05).There were significant differences in JOA score (10.60 ±2.33 vs.24.50 ± 1.25) and ODI [(53.93 ± 10.46)％ vs.(18.02 ± 5.78) ％] before operation and after the final follow-up in group B (P ＜0.05).However,there was no statistically significant difference in the follow-up intervals between group A and group B (P ＞ 0.05).Conclusion Posterior dural incision is an effective method for the treatment of upper lumbar disc herniation.