腰椎间盘突出症单纯开窗髓核摘除术远期疗效及相关因素分析

Long-term outcome analysis of standard discectomy for lumbar disc protrusion and its influencing factors

目的探讨单纯开窗髓核摘除术治疗腰椎间盘突出症的远期疗效及相关因素。方法回顾性研究自1996年2月至1999年5月在我院接受单纯开窗髓核摘除术治疗的82例单节段非特殊类型的腰椎间盘突出症患者,随访84-123个月,平均为(103．3±11．7)个月。记录患者手术减压时病变椎间盘的类型及最后随访时的复发例数。采用X线摄片及MRI检查测量椎间盘高度比值、椎间盘突出类型。分别记录术前和最后随访时的日本骨科学会评分(JOA评分)、下腰痛及下肢根性痛视觉模拟评分(VAS评分),运用改良的Macnab分级法记录最终的临床疗效。结果术前:JOA评分为5-9分,平均为(6．5±1．3)分;下腰痛的VAS评分为0-8分,平均为(4．8±0.5)分;下肢根性痛的VAS评分为4-10分,平均为(7．2±0．7)分．术后终末随访时:JOA评分为10- 14分,平均为(13．2±1．8)分;下腰痛的VAS评分为0-10分,平均为(1．8±0．3)分;下肢根性痛的VAS评分为0-7分,平均为(1．2±0．2)分。手术前、后JOA评分的平均改善率为(78．8±10．3)％。术前MRI检查为包含型和非包含型椎间盘突出的例数分别为62和20例,终末随访7例复发,且均为包含型,其中L4-L5 5例,L3-L4和L5-S1各1例。终末随访的临床优良率为80%。结论只要严格遵守手术指征,单纯开窗髓核摘除术治疗腰椎间盘突出症能获得较好的长期临床疗效。患者术前较早的椎间盘退变及术后椎间隙高度降低均不同程度地影响手术的长期疗效;术后下肢根性痛的改善优于下腰痛,复发性椎间盘突出多见于L4-L5节段和包含型椎间盘突出者。

Objective To appraise the long-term outcomes of standard discectomy for lumbar disc protrusion and to analyze the related factors. Methods We retrospectively studied 82 cases of nonspecific lumbar disc protrusion which involved single segment. All of them were treated with simple standard discectomy during February 1996-May 1999. The follow-up duration was 84-123 months, averagely （103.3 ± 11.7） months. The following parameters was recorded： Body Mass Index（BMI）, occupation, diabetic history, pathological types of protruded lumbar disc and the number of recurrent disc protrusion at the final follow-up. Using X-ray and MRI techniques, we studied the disc-vertebra height ratio and the pathological types of protruded lumbar disc. The respective scales of Japanese Orthopedics Association（JOA） and VAS（low back pain/sciatica） before operation and at final follow-up and the modified Macnab＇s clinical outcomes were also recorded. Results The average scales before operation were as follow： JOA 6.5 ± 1.3（5-9）, VAS of low back pain 4.8± 0.5（0-8）, VAS of sciatica 7.2 ± 0.5（4-10） ; at the final follow-up, the above parameters were 13.2 ± 1.8（10-14）, 1.8 ± 0.3 （0-10） and 1.2 ± 0.2（0-7）, respectively. The average improvement rate of JOA scale was （78. 8 ± 10. 3）%. Before operation, there were 62 cases of contained disc protrusion and 20 cases of uncontained disc protrusion at the MRI films. At the final follow-up, there were 7 cases of recurrent disc protrusion. At the first operation, all patients had disc protrusion; at the final follow-up, 7 cases had recurrent disc protrusion, including 5 cases at L4-L5, one each at L3-L4 and L5-S1 level, respectively. The final excellent rate was 80% （by modified Macnab method）. Conclusions With strict surgical indi cation, good long term outcomes could be expected with standard discectomy. The relative high BMI, strenuous work or sedentary posture, history of diabetes, early disc degeneration as well as the narrow disc height after opera- tion can affect the long-term outcome. The post-operative improvement on sciatica is better than that on low back pain. Recurrent disc protrusion is found more at the L4-L5 level and/or in cases of disc protrusion. （Shanghai Med J, 2007, 30：336-339）