腰椎间盘突出症常用手术方式的评价和疗效分析

Surgical Procedures for Lumbar Disc Herniation and their Curative Effects

目的对腰椎间盘突出症的不同手术方式进行系统地评价和进一步的疗效分析。方法140例患者中行开窗术式者(A组)40例,半椎板切除术式者(B组)40例,全椎板切除术式者(C组)30例,椎间盘镜髓核摘除(D组)30例,采用信访结合门诊复查的形式随诊5～10年,并进行远期疗效观察。结果经统计学分析,各组优良率比较P<0.05,显示各组开窗术式者(A组)40例,半椎板切除术式者(B组)40例,全椎板切除术式者(C组)30例,椎间盘镜髓核摘除(D组)30例优良率不相等或不完全相等。A组及D组病例按半年内及半年后疗效优良者均在90%以上,而疗效优者均占80%左右;而B组及C组半年内疗效较满意,但半年以后疗效优者仅有50%～60%。腰椎间盘突出症术后的并发症主要以硬脊膜撕裂伤(7例),脑脊液漏(6例),切口感染及椎间盘炎(4例)为主。同时A组出现椎间不稳的病例占总数的12.5%,而B组出现椎间不稳的病例占35.0%,明显高于A组。且以D组的手术并发症为最少。结论临床医生应严格掌握腰椎间盘突出症的手术指征选择适宜的术式,对腰椎间盘突出症的不同手术方式进行系统评价具体的疗效分析,才能取得良好的治疗效果。

Objective To explore different surgical procedures for lumbar disc herniation（laminectomy windows, semi-laminar or total laminectomy and discectomy MED ）, and to evatuate their curative effects. Methods In 140 cases,40 cases were of fenestration-type （Group A）, 40 cases of semi-Laminectomy-type（Group B）, 30 cases of whole-Laminectomy-type（Group C） and 30 cases of microendoscopic discectomy （ Group D）, with a follow-up of 5 to 6 years and an observation of long-term curative effect. Results Statistical analysis showed the excellent rate in each group was 40 cases of fenestration-type（Group A）, 40 cases of semi-Laminectomy-type（Group B）, 20 cases of lamineetomy excision-type（Group C） and 30 cases of endoscopic discectomy disc（Group D）, respectively, P〈 0.05. The curative effect excellent rate was about 80% in Group A and Group D but 50%-60% in Group B and Group C. The postoperative complications of lumbar disc herniation were mainly dural laceration（7 cases）, cerebrospinal fluid leakage（six cases）,incisional infection and spondylodiscitis（4 cases）. The intervertebral instability accounted for 12.5 % in Group A but 35.0% in Group B,with the former higher than the latter. There were the fewest postoperative complications in Group D. Conclusion Surgeons should select feasible surgical procedures for lumbar disc herniation based on surgical indications and evaluate the curative effects of different surgical procedures in order to obtain a better therapeutic effect.