显微椎间盘镜下黄韧带不同干预方式的结果分析

Comparison of the follow-up results in different interventions for flavum ligament operation during microendoscopic discectomy

目的:探讨显微椎间盘镜下黄韧带的不同干预方式对临床疗效和随访CT图象的影响。方法:92例患者随机分为2组,A组进行常规显微椎间盘镜下髓核摘除术,B组保留黄韧带行髓核摘除术。分别于术前1天、术后3周、3个月、1年进行资料采集。采用Oswestry功能障碍指数(ODI)进行疗效评估,计算改善率。术后1年对随访CT图象进行粘连程度分级,两组间不同粘连级别的人数进行构成比分析,对所有患者的CT分级与其术后1年改善率进行相关性分析。结果:术前1天ODI均数及术后3周改善率比较均未见显著性差异(P>0.05)。术后3个月及术后1年,改善率两组间比较均有极其显著的差异(P<0.001)。A组改善率术后3个月较术后3周略有提高(P>0.05),术后1年出现下降(P<0.05),术后1年与术后3周改善率比较无显著性差异(P>0.05);B组改善率总体上呈持续提高趋势,术后3周与术后3个月改善率比较无显著性差异(P>0.05),术后1年与术后3个月、术后1年与术后3周改善率比较可见显著性差异(P<0.05)。术后1年CT分级,两组间各分级人数构成具有显著性差异(P<0.05)。各患者CT分级及其改善率的相关性分析,结果显示存在极其显著的差异(P<0.01)。结论:对黄韧带的不同干预方式能够明显影响术后CT表现出来的椎管内瘢痕粘连的程度差异。椎管内粘连程度与临床疗效呈显著的负相关,即椎管内粘连程度越重,相应的临床疗效越低。

Objective：To evaluate the effects of different interventions for flavum ligament in clinical results and CT outcomes on microendoseopie disceetomy （MED）. Methods：Ninety-two patients were divided into two groups at random. Both groups were disposed with microendoscopie diseeetomy, differentiated from each other by flavum ligament operation. Data at 1 day pre-operation, 3 weeks, 3 months and 1 year post-operation were followed up, respectively. The clinical effects were assessed by Oswestry Disability Index, and the improvement rates were also calculate. CT films taken from 1 year follow-up were graded, and the constitution of different graded cases were analyzed between 2 groups. The Correlation between graded CT films and corresponding improvement rates were analyzed. Results：Both ODI at 1 day pre-operation and improvement rates at 3 weeks post-operation were observed no significant difference （P 〉 0.05 ）. At 3 months and 1 year post-operation,the improvement rates between two groups had significant difference（P 〈 0.001 ）. In group A,the improvement rates increased at 3 months post-operation in contrast to 3 weeks post-operation（P 〉 0.05）,which declined 1 year later （P 〈 0.05）. No significant difference between 3 weeks and 1 year post-operation was observed （P 〉 0.05）. In group B,the improvement rates increase continually. There was no significant differenee（P 〉 0.05 ） between 3 weeks and 3 months post-operation, whereas significant differences were observed between 1 year and 3 months, 1 year and 3 weeks（P 〈 0.05）. At 1 year post-operation, the constitution of different graded CT films between two groups had significant difference （P 〈 0.05 ）. Correlative analysis revealed obvious difference between each graded CT and corresponding improvement rate （P 〈 0.01 ）. Conclusion： Different interventions for flavum ligament can obviously affect the variances of epidural fibrosis that CT films manifested. There was a negative correlation between fibrosis degrees and clinical effects.