不同手术方案治疗未成年腰椎间盘突出症疗效观察

Comparison of different surgical procedures in the treatment of patients with lumbar disc herniation

目的探讨单纯椎板开窗髓核摘除手术方式和椎板开窗髓核纤维环缝合手术方式治疗未成年腰椎间盘突出症患者的临床效果。方法选取2013-09-01-2016-09-01安阳市人民医院行手术治疗的未成年腰椎间盘突出症患者作为研究对象,根据组间基本特征具有可比性的原则及手术方式,选择纤维环缝合组与髓核摘除组。纤维环缝合组患者39例,髓核摘除组47例。纤维环缝合组患者采用椎板开窗髓核纤维环缝合手术治疗,髓核摘除组采用单纯椎板开窗髓核摘除手术治疗。分析比较2组患者手术相关指标、日本骨科协会(JOA)评分及临床疗效等。结果2组患者切口长度及术后住院时间比较,差异无统计学意义,均P>0.05。纤维环缝合组出血量为(56.3±5.9)mL,少于髓核摘除组的(59.7±4.1)mL,t=3.041,P=0.003;手术时间为(85.2±6.3)min,长于髓核摘除组的(81.3±4.8)min,t=3.256,P=0.002。髓核摘除组和纤维环缝合组治疗前JOA评分比较,差异无统计学意义,P>0.05;治疗后髓核摘除组JOA评分为(17.90±2.64)分,高于纤维环缝合组的(10.83±1.96)分,差异有统计学意义,t=13.849,P<0.001。纤维环缝合组患者治疗有效率为97.44%,髓核摘除组为93.62%,差异无统计学意义,χ2=0.104,P=0.747。结论单纯椎板开窗髓核摘除手术方式和椎板开窗髓核纤维环缝合手术方式治疗未成年腰椎间盘突出症患者均有显著效果,可在临床上根据情况灵活选择手术方式。

Objective To explore the clinical effects of the surgical treatment of laminectomy and nucleus pulposus removal by laminectomy alone and the surgical treatment of laminectomy and nucleus pulposus fibrosus suture in juvenile patients with lumbar disc herniation.Methods The adolescent patients with lumbar disc herniation who were treated in our hospital on September 1,2013 and September 1,2016 were selected as study subjects.According to the principle of comparability of basic characteristics between groups and the surgical method,the annular fusion group and the nucleus pulposus excision group were selected.There were 39 patients in the annulus fibrosus suture group and 47 patients in the nucleus pulposus removal group.The patients in the annulus fibrosus suture group were treated with lamina fenestration and nucleus pulposus suture,and the nucleus pulposus group was treated with lamina fenestration and nucleus pulposus.After the treatment,the two groups of patients were statistically summarized related data such as surgery-related indicators,Japan Orthopedic Association(JOA)score,patient efficacy for comparative analysis.Results There was no significant difference in incision length and postoperative hospital stay between the two groups(P>0.05).The blood loss in the annulus suture group was(56.3±5.9)ml,which was less than(59.7±4.1)ml in the nucleus pulposus group,t=3.041,P=0.003.The operation time was(85.2±6.3)min,which was longer than the nucleus pulposus removal group(81.3±4.8)min,the difference was statistically significant,t=3.256,P=0.002.There was no significant difference in JOA score between the nucleus pulposus removal group and the annulus fibrosus group before treatment(P>0.05).After treatment,the JOA score in the nucleus pulposus group was 17.90±2.64,which was significantly higher than the10.83±1.96 in the annulus suture group.The difference was statistically significant,t=13.849,P<0.001.The effective rate was 97.44%in the annulus suture group and 93.62%in the nucleus pulposus group.There was no significant difference in the effective rate between the two groups(χ2=0.104,P=0.747).Conclusions The surgical treatment of single laminectomy with nucleus pulposus and laminectomy with nucleus pulposus suture have significant effect in the treatment of juvenile lumbar intervertebral disc patients.Therefore,it can be selected flexibly according to the clinical situation.