腰椎间盘突出症419例3种非手术疗法疗效分析

Treatment Effects on 419 Cases of Lumbar Disc Herniation with Three Kinds of Nonoperative Treatments

为比较下腰痛非手术疗效，４１９例腰椎间盘突出症患者采用腰椎牵引（甲组１９５例）、激素硬膜外注射（乙组１９２例）及经皮穿刺椎间盘切吸术或胶原酶溶解术（丙组３２例）进行治疗和随访，采用改良Ｍａｃｎａｂ标准评定。结果：优良率甲组４９％，乙组６６％，丙组８４％，Ｐ＜０．０１；甲组疗效与病程相关，病程＜６个月疗效较好（Ｐ＜０．０５）；平均治疗次数有甲组＞乙组＞丙组的倾向。结论：单纯腰椎牵引对病程较短者疗效较好；病程较长，神经根刺激症状明显者加用激素硬膜外注射可提高疗效；经腰牵、激素硬膜外注射等非手术治疗无效者，如严格掌握适应证和操作技术。

Four hundred and ninteen cases of lumbar disc herniation were devided into 3 groups. Group A (195 cases) treated with lumbar traction, and group B (192 cases) with steriod epidural injection plus lumbar traction, and group C (32 cases) with percutaneous discectomy or collagenase nucleolysis. They were followed up in the out patient dept. for 3 months to 3 years. Modified Macnab 4 categery grading was employed as criteria of the therapy. The results showed that: ①excellent and good results were 49% in group A, 66% in group B, and 84% in group C ( P <0.01); ②Treatment effects correlated with course of disease in group A; ③Courses of treatment were different, which were group A>group B>group C. These results indicated that: ①Cases with shorter course of disease (<6M) usually responded well to lumbar traction. ②Cases with longer course of disease or with siatic irritation should give both traction and steroid epidural injection. ③Cases did not respond well to above methods could get good results by percutaneous discectomy or collagenase nucleolysis.