600例腰椎间盘突出症两种治疗方法的选择及评估

Treatment of 600 Lumber Disk Herniation patients between conservative and surgical methods

目的探讨采用保守和手术治疗腰椎间盘突出症的临床疗效。方法2002年9月至2006年9月,对600例腰椎间盘突出患者进行治疗,采用保守跟手术两种方法进行治疗。其中男266例,女334例,平均47.4岁。治疗前、后参考JOA score,结合治疗前后症状、体征及ADL评分拟定疗效评定标准进行疗效评分。结果经过治疗后,保守组和手术组总有效率分别为91.9%、94.2%经过统计学处理差异无统计学意义(P>0.05);各组治疗前后比较有明显差异(P<0.05)。结论保守和手术治疗对腰椎间盘突出症均具有良好的治疗效果,保守治疗基本无创,无并发症,安全,无痛苦,费用低;而采用后路椎弓根内固定系统结合横突间植骨术,既能够对椎管做到彻底减压,又能一次性重建腰椎稳定性,中、早期随访效果良好,是基层医院治疗腰椎间盘突出症较满意的治疗方法。

Objective To explore the curative effect of lumber disk herniation by the treatment between conservative and surgical methods. Methods From September 2002 to September 2006,600 cases （266 male and 334 female,with the average age of 52. 2 years）were given conservative or surgical methods. JOA score, symptom, physical sign and ADL score were given respectively before treatment and in follow-up to observe the curative effect. Results After treatment, the total effective rate of the conservative group and the sur- gery group was 91.9% and 94. 2% with no statistically significant difference （ P 〉 0.05 ） , the two groups were compared with significant difference（ P 〈 0. 05 ） before and after the treatment. Conclusion Conservative and surgical treatments of lumbar disc herniation all had good results. Conservative treatment had neither wound nor complaints,but with safety and low-cost. The method of internal fixation by lateral neck of vertebra and bone graft between proeessus transversus can give not only a thorough decompression of the spinal canal but also a one-time reconstruction of spinal stability ,with a good effect in the early and intermediate follow-ups. So it is a satisfactory method in the grass-roots hospitals for the treatment of lumbar disc herniation.