髓核摘除联合Isobar非融合内固定治疗腰椎间盘突出症

EFFECTIVENESS OF DISCECTOMY COMBINED WITH Isobar NON-FUSION INTERNAL FIXATION IN TREATING LUMBAR DISC PROTRUSION

目的评价髓核摘除联合Isobar非融合内固定治疗腰椎间盘突出症的近期疗效。方法 2006年5月-2008年5月,对65例单间隙腰椎间盘突出症患者分别采用髓核摘除联合Isobar非融合内固定(A组,34例)和单独髓核摘除(B组,31例)治疗。A组男18例,女16例;年龄23～51岁,平均38.8岁。责任节段:L2、3 1例,L3、4 4例,L4、5 20例,L5、S1 9例。分型:突出型11例,脱出型16例,游离型7例。病程1～66个月,平均7.2个月。B组男19例,女12例;年龄21～49岁,平均39.2岁。责任节段:L3、4 2例,L4、5 24例,L5、S1 5例。分型:突出型13例,脱出型15例,游离型3例。病程3周～72个月,平均6.5个月。两组患者一般资料比较差异无统计学意义(P>0.05),有可比性。手术前后采用疼痛视觉模拟评分(VAS)及Oswestry功能障碍指数(ODI)进行比较评价,并动态观察术后责任椎间隙高度变化情况。结果两组患者均获随访,随访时间24～49个月,平均32个月。术后A、B组患者腰、腿痛症状均明显改善,B组1例发生术后脑脊液漏,经处理后治愈。随访期间两组均无内固定物松动、断裂等并发症发生。A、B组术后3周、3、6个月和1、2年腰、腿痛VAS均较术前显著改善(P<0.05);术后1、2年,A、B组间腰痛VAS比较差异有统计学意义(P<0.05),其余各时间点腰痛VAS及手术前后各时间点腿痛VAS A、B组间比较差异均无统计学意义(P>0.05)。术后2年两组ODI与术前比较差异均有统计学意义(P<0.05),但A、B组间比较差异无统计学意义(P>0.05)。术后各时间点A组责任椎间隙高度均较术前增加(P<0.05);B组较术前下降,术后3周及3个月与术前比较差异无统计学意义(P>0.05),术后6个月、1年及2年与术前比较差异有统计学意义(P<0.05)。A、B组间术后各时间点责任椎间隙高度比较差异均有统计学意义(P<0.05)。结论髓核摘除联合Isobar非融合内固定治疗节段隙腰椎间盘突出症的近期疗效满意,患者术后腰痛缓解程度较单独髓核摘除术更明显,可能与其能维持术后责任椎间隙高度有关。

Objective To evaluate the short-term results of discectomy combined with Isobar non-fusion internal fixation.Methods Between May 2006 and May 2008,65 cases of single segment lumbar disc protrusion were random surgically treated by discectomy combined with Isobar non-fusion internal fixation（34 cases,group A） and single discectomy（31 cases,group B）,respectively.In group A,there were 18 males and 16 females with an average age of 38.8 years（range,23-51 years）;the involved segments were L2,3（1 case）,L3,4（4 cases）,L4,5（20 cases）,and L5,S1（9 cases）,including 11 cases of protrusion type,16 cases of prolapsed-type,and 7 cases of sequestered type;and the mean disease duration was 7.2 months（range,1-66 months）.In group B,there were 19 males and 12 females with an average age of 39.2 years（range,21-49 years）;the involved segments were L3,4（2 cases）,L4,5（24 cases）,and L5,S1（5 cases）,including 13 cases of protrusion type,15 cases of prolapsed-type,and 3 cases of sequestered type;and the mean disease duration was 6.5 months（range,3 weeks to 72 months）.There was no significant difference in the general data between 2 groups（P 〉 0.05）.The surgical results were assessed by visual analogue scale（VAS） for back/leg pain and the Oswestry disability index（ODI）.The height of involved intervertebral space was measured dynamically after operation.Results The patients of two groups were followed up 32 months on average（range,24-49 months）.All clinical symptoms of the patients were notably improved in 2 groups.One patient in group B experienced postoperative cerebral fluid leakage,and was cured after extubation,changing posture,and other measures.There was no implant failure,such as pedicle fracture,screw loosening,or screw malposition during the follow-up.The ODI and VAS were significantly improved after operation.The back and leg pain VAS scores at each time point were decreased significantly when compared with those before operation（P 〈 0.05） in 2 groups.There were significant differences in back pain VAS（P 〈 0.05） between groups A and B at 1 and 2 years after operation.There was significant difference in the ODI score（P 〈 0.05） at 2 years when compared with that before operation in 2 groups,but there was no significant difference between 2 groups（P 〉 0.05）.After operation,the mean height of involved intervertebral space was increased significantly（P 〈 0.05） when compared with preoperative value in group A,while the height had a gradual decline at 3 weeks and 3 months（P 〉 0.05）,and had a significant decline at 6 months,1 year,and 2 years（P 〈 0.05） when compared with preoperative value in group B.There were significant differences in the height of involved intervertebral space between groups A and B at each time point after operation（P 〈 0.05）.Conclusion Discectomy combined with Isobar non-fusion internal fixation presents with satisfactory short-term results;moreover,it can better relieve back pain in comparison with single discectomy,which possibly related to the preservation of responsible intervertebral spaces.