腰椎髓核摘除术远期疗效评价

Long-term results of discectomy for lumbar disc herniation

目的评价腰椎间盘突出症患者行髓核摘除术后的远期疗效。方法对1981～1993年在三家医院行髓核摘除术(开窗法、半椎板切除和全椎板切除)治疗的1000例腰椎间盘突出症患者进行信件问卷随访,分析患者术后症状缓解、恢复工作情况及对手术的满意程度,并对放射学资料保留完整的患者手术前后的腰椎间隙高度和稳定性进行对比研究。结果共收到有效回信104封,随访率为10.4%。(1)临床疗效:开窗组(37例)的优良率为83.8%,半椎板组(44例)为77.3%,而全椎板组(23例)为43.5%。开窗组与半椎板组比较差异无显著性(P>0.05),开窗组、半椎板组分别与全椎板组比较差异均有显著性(P<0.01,P<0.05)。(2)术后恢复工作情况:开窗组的平均恢复工作时间和恢复原工作率分别为4.3个月和84.6%,半椎板组分别为4.6个月和86.4%,全椎板组分别为4.4个月和77.8%。(3)影像学改变:全部病例的施术腰椎间隙高度在术后均有不同程度的丢失,术后9年平均丢失36%,但绝大多数患者未出现局部不稳。结论(1)开窗法和半椎板切除髓核摘除术治疗腰椎间盘突出症可获得良好的远期疗效,(2)髓核摘除术后椎间隙高度下降不一定导致椎间不稳和神经根受压,(3)髓核摘除术仍是治疗腰椎间盘突出症的可靠而有效的方法。

Objective To evaluate the long-term clinical and radiological results of discectomy for lumbar disc herniation. Methods A questionnaire following-up was conducted in 1 000 patients who underwent discectomy for lumbar disc herniation in three hospitals. All the operations were performed by the authors during 1981-1993. Postoperative symptom alleviation, working ability and self-satisfaction of the patients were documented. A comparative pre/post-operative radiological study was also performed to measure the postoperative height loss of involved disc spaces and to evaluate the segmental stability of lumbar spine. Results One hundred and four replied questionnaire letters were retrieved. The following-up rate was 10.4%, the average following-up period was 12.7 years (8-20 years). According to the surgical procedure, the patients were classified as 'open-window', hemilaminectomy and total laminectomy groups. The excellent/good rates in 'open-window', hemilaminectomy and total laminectomy group were 83.8%, 77.3% and 43.5% respectively. There was no significant difference between the 'open-window' group and hemilaminectomy group (P > 0.05). However, there was significant difference between the 'open-window' or hemilaminectomy group and total laminectomy group. The time of returning to work and the rate of returning to previous work were 4.3 months and 84.6% in 'open-window' group, 4.6 months and 86.4% in hemilaminectomy group and 4.4 months and 77.8% in total laminectomy group respectively. The height loss of involved disc spaces was discovered in the postoperative radiographs in all the patients. However, no segmental instability was found in the majority of these patients. Conclusion 1) 'Open-window' or hemilaminectomy may achieve satisfactory long-term results for treatment of lumbar disc herniation. 2) No definite correlation exists between the height loss of involved disc space and segmental instability or nerve root entrapment. 3) Discectomy is still a reliable and effective surgical procedure for the treatment of lumbar disc herniation before the reliability of any disc replacement is confirmed in the long-term follow-up survey.