CAJ | 학술논문

目的：探讨巨大型腰椎椎间盘突出症的发病特点及手术疗效。方法回顾分析5年来手术治疗的腰椎椎间盘突出症患者共1441例，将其分为巨大型172例、普通型1269例，随访记录其发病年龄、性别、症状特点、突出形态、手术方式、手术并发症、术后疗效、术后复发率等，并行统计学对比分析2组在各方面的异同。结果1441例患者资料完整，总体男女比2．99∶1，平均年龄43．4岁。2组之间比较：平均年龄2组之间差异无统计学意义（ P＞0．05）；性别比例均为男性好发，巨大型组男女比明显低于普通型组（P＜0．05）；平均病程巨大型组明显短于普通型组（P＜0．05）；巨大型组与普通型组相比，双侧症状更多、肌力下降者更多、马尾综合征更多、中央型比例更高、椎间盘脱出者更多（P＜0．01）；巨大型组中实施双侧减压明显高于普通型组（P＜0．01）；手术并发症发生率，包括术中脑脊液漏发生率、切口感染率、深部感染率2组之间差异无统计学意义（P＞0．05）；手术优良率分别为94．12％、93．78％，2组之间差异无统计学意义（P＞0．05）；术后复发率巨大型组明显低于普通型组（P＜0．05）。结论巨大型腰椎椎间盘突出症与普通型相比有截然不同的临床特点，其手术治疗可达到等同于普通型的良好疗效，术后复发率低于普通型腰椎椎间盘突出症。
목적：탐토거대형요추추간반돌출증적발병특점급수술료효。방법회고분석5년래수술치료적요추추간반돌출증환자공1441례，장기분위거대형172례、보통형1269례，수방기록기발병년령、성별、증상특점、돌출형태、수술방식、수술병발증、술후료효、술후복발솔등，병행통계학대비분석2조재각방면적이동。결과1441례환자자료완정，총체남녀비2．99∶1，평균년령43．4세。2조지간비교：평균년령2조지간차이무통계학의의（ P＞0．05）；성별비례균위남성호발，거대형조남녀비명현저우보통형조（P＜0．05）；평균병정거대형조명현단우보통형조（P＜0．05）；거대형조여보통형조상비，쌍측증상경다、기력하강자경다、마미종합정경다、중앙형비례경고、추간반탈출자경다（P＜0．01）；거대형조중실시쌍측감압명현고우보통형조（P＜0．01）；수술병발증발생솔，포괄술중뇌척액루발생솔、절구감염솔、심부감염솔2조지간차이무통계학의의（P＞0．05）；수술우량솔분별위94．12％、93．78％，2조지간차이무통계학의의（P＞0．05）；술후복발솔거대형조명현저우보통형조（P＜0．05）。결론거대형요추추간반돌출증여보통형상비유절연불동적림상특점，기수술치료가체도등동우보통형적량호료효，술후복발솔저우보통형요추추간반돌출증。
Objective To explore the epidemiological characteristics, clinical features and operational outcome of huge lumbar disc herniation.Methods A total of 1 441 patients with lumbar disc herniation accepting surgical treatments including 172 cases of huge lumbar disc herniation(HLDH) and 1 269 cases of no huge lumbar disc herniation(NHLDH) were retro-spectively analyzed.Gender, age, clinical manifestation, levels of disc herniation, herniation morphology, surgical approach, surgical outcomes and recurrence rate were recorded and statistically analyzed.Results All of 1 441 patients were completely recorded.The total male/female ratio is 2.99∶1, and the average age was 43.4 years.Between the 2 groups, the average age was not significantly different(P>0.05).The male-female ratio of HLDH was significantly smaller than that of NHLDH(P<0.05).HLDH had a smaller duration of symptoms than NHLDH(P<0.05).Compared with NHLDH, HLDH were more prone to be non-contained, centralherniation and present bilateral symptoms, motor deficit, caudaequina syndrome ( P<0.01).Patients with HLDH accepted more bilateral laminectomies(P<0.001).And the outcome of operation, complications of dural tear, superficial wound infection, deep wound infection showed no differences between the 2 groups(P>0.05). Recurrence rate of HLDH was significantly lower than that of NHLDH(P<0.05).Conclusion Compared with NHLDH, HLDH has distinct clinical features, equally satisfactory operation outcomes and a lower postoperational recurrence rate.