967例腰椎间盘突出症术后远期疗效分析

Analysis of Postoperative Long-term Result in 967 Cases with Prolapse of Lumbar Intervertebral Disc

腰椎间盘突出症经手术治疗者约10％～12％,本文就有关远期疗效问题进行了探讨．1975年～1993年治疗967例，优良率93．2％,主要问题：腰无力89例（12.8％，腿麻木79例（11.3％），腿痛35树（5.0％），性功能低下31例（4.4％），二便费力等。结果提示：①选择合适的手术方式，有利于减少硬膜外及神经很周围纤维化及瘢痕粘连的影响，减少腰椎不稳的可能因素．①严格选择手术适应证，不能扩大化；对明确的巨大突出物，不能延误手术，以挽救神经功能．③体征明确，术中应找到病变部位，不能轻易结束手术．④剥离、牵拉马尾神经时需谨慎，可能有助于改善或防止脊髓功能障碍．⑤尽早康复训练，对提高腰背肌功能、减少下腰痛综合征是有益的．

The lifetime incidence of disc surgery has been calctilated as 10%～12%, and the long-term results of the operative treatment are addressed in the present study. A total of 967 patients had been operated between 1975～1993 at this inshtution. The excellent and gnod rate was 93.2%. The major sequellae of discoidectomy include: low back weakness 89 (12.8%), numbness in the lower extrennty 79(11.3%), pain in the lower extremity 35(5.0%), sexual disorder 31(4.4%), and dyschezia and dysuria.The results suggest that ① selechon of appropriate operative tectriques is of importance in that it can reduce the adverse effects of fibrosis and scar adhesion around the nerve roots, and it can lessen the potential for lumbar instability; ② it is advisable to be strict with indications for operation which must not be unduly extended, while pronounced protrusion should be removed without any delay to prevent irreversible neurologic injury; ③ the operation should not be concluded rashly before having located and extirpated the lesion in view of distinct signs; ④ sexual disorder and bowel, bladder dysfunction must not be disregarded with close attention being paid when dissetrong and retracting the cauda equina; and; ⑤ the earliest pessible rehabilitation makes for reinforcement of lumbar muscufature which would help to reduce low back pain syndromes.