腰椎间盘突出症三术式远期疗效的比较

A Comparitive Study of Long-Term Results of Three Different Approaches for Surgical Treatment of Lumbar Disc Herniation

目的:为了解椎板间开窗、半椎板切除、全椎板切除髓核摘除三术式的远期疗效,对370例行不同方式腰椎间盘髓核摘除术患者进行了远期疗效随访。材料和方法:随机抽取1983～1995年间行开窗术患者300例,半椎板切除术者40例,全椎板切除术者30例,术前及术后5～11年分别进行症状比较和功能测试。结果:三组患者术前在年龄结构、病变范围、症状方面的差异均无显著性意义。术后5～11年,三组患者两两之间在症状和体征方面的差异有显著性意义,三组患者主观感觉优良率分别为97%、84%、17%。结论:三术式中椎板间开窗组的疗效最好,并发症最少;而全椎板切除组的疗效最差,腰椎不稳、肌萎缩和硬脊膜压迫、粘连等并发症的发生率最高。半椎板切除组的情况介于中间。文中讨论了造成此差异的原因。

Objectives: To compare the long-term results of three different surgical approaches for treatment of lumbar disc herniation. Methods: Three-hundred and seventy patients undergone operative treatment for lumbar disc herniation during 1983 to 1995 were reviewed. Groups A consisted of 300 cases were done through fenestration. Group B of 40 cases were done through semi-laminectomy, and group C of 30 cases through total-lamineetomy. The symptoms and signs were evaluated before operation and at five to eleven years follow-up. Results: There was no significant difference between three groups in symptoms and signs before operation. However, significant difference was seen at 5 to 11 years follow-up period, giving an excellent and good rate of 97%, 84%, 17% respectively in the groups A, B and C. Conclusion: The fenestration lumbar discectomy had the best outcome and the least complications, whereas the total-laminectomy diseectomy bore the worst outcome and the frequently encountered complications such as instability, dura compression and muscular weakness.