摘要
目的:探讨三种术式治疗复发性腰椎间盘突出症的疗效分析。方法:对我院2004年4月~2009年10月收治的随访资料完整的78例腰椎间盘突出症术后复发再次手术患者进行回顾性研究。按照再次术前患者情况及手术方法分三组:A组27例,术前无腰椎失稳、退变性滑脱或椎管狭窄,再次行椎间盘摘除术;B组15例,术前合并腰椎失稳、退变性滑脱或椎管狭窄,行椎间盘摘除+后外侧融合术(posterolateral fusion,PLF);C组36例,术前合并腰椎失稳,退变性滑脱或椎管狭窄,行椎间盘摘除+后路腰椎椎体间融合术(posterior lumbar interbody fusion,PLIF),B组、C组患者依据术前具体病情,术中均采用椎弓根螺钉内固定术。采用日本骨科学会(JOA)29分评分系统和腰痛及腿痛视觉疼痛评分(VAS)两项指标对患者术前、术后和末次随访时的神经功能及自觉症状进行评价,计算改善率,并对结果进行统计学分析。结果:78例患者再次术后均获得随访,随访时间6~36个月,平均24个月。JOA评分术前A组为9.96±2.59,B组为10.20±2.37,C组为9.14±3.16;术后2个月A组为20.37±5.21,B组为22.60±6.62,C组为21.45±6.09;末次随访A组为19.85±6.45,B组为20.40±6.47,C组为20.92±5.51。各组JOA评分与术前相比有统计学意义(P<0.05)。各组术前、术后及末次随访腰腿痛(VAS)评分,经配对t检验,差异有显著性(P<0.05);结论:腰椎间盘突出症术后复发根据不同病情采用不同的手术方式治疗,可以取得满意的临床效果。
Objective:To investigate the varied surgical outcome for recurrent lumbar disc herniation. Method:From April 2004 to October 2009,78 patients with recurrent lumbar disc herniation (32 males,46 females)with the mean age of 52.2 years (range,27-79 years) were involved in this study.Patients were assigned into 3 groups according to preoperative diagnosis and revision protocols classification as followers: group A (n=27) with no lumbar vertebrae instablility or lumbar spinal stenosis and underwent discectomy alone;group B (n=15) with lumbar vertebrae instability or lumbar spinal stenosis and underwent discectomy and posterolateral fusion(PLF);group C(n=36) with lumbar vertebrae instability or lumbar spinal stenosis and underwent discectomy and posterior lumbar interbody fusion (PLIF);both group B and group C had vertebral pedicle screw fixation;the clinical results of all patients were analyzed by JOA score (29 score)and VAS score.Result:All patients were followed up for an average of 24 months (range,6 months-36 months).Before surgery,the JOA score for group A,B and C was 9.96±2.59,10.20±2.37 and 9.14±3.16 respectively;20.37± 5.21,22.60±6.62 and 21.45±6.09 for 2 months later respectively;and 19.85±6.45,20.40±6.47 and 20.92±5.51 respectively for final follow-up,which showed significant difference compared with preoperative ones (P0.05). The VAS score for low back pain and leg pain in the group A,B and C showed significant difference compared with preoperative ones (P 0.05).Conclusion:Surgical management for recurrent lumbar disc herniation(RLDH)should be individualized.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
北大核心
2010年第9期730-735,共6页
Chinese Journal of Spine and Spinal Cord
关键词
腰椎间盘突出症
复发
再手术
疗效
Lumbar disc herniation
Recurrent
Reoperation
Outcomes