椎板开窗髓核摘除术在腰椎间盘突出症中的远期疗效研究

The long-term efficacy of laminectomy with discectomy for lumbar disc herniation

目的探讨椎板开窗髓核摘除术在腰椎间盘突出症治疗中的远期疗效。方法对本院收治的64例腰椎间盘突出症患者进行椎板开窗髓核摘除术的治疗，开窗大小约为1．5cm×1．5cm，术后常规抗感染治疗和功能恢复训练，随访3年以上，对患者的近、远期疗效进行分析记录，并对不同病理分型患者远期疗效进行分析。结果患者远期疗效优良率为75．0％，近期疗效优良率为90．6％，远期疗效明显差于近期疗效（P〈0．05）；不同病理类型中，Ⅳ型远期疗效最好，为92．9％，Ⅱ型远期疗效为83．3％，Ⅲ型为75．0％，Ⅰ型最差为62．5％。结论椎板开窗髓核摘除术患者随着时间的推移，其疗效逐渐下降；对于椎间盘髓核突出较大，纤维环破损较小患者的远期疗效比较好。

Objective To explore the long-term efficacy of laminectomy with discectomy in the treatment of lumbar disc herniation. Methods 64 patients with lumbar disc herniation underwent laminectomy with discectomy, with a window of 1.5 cm × 1.5 cm in size. All the patients received conventional antibiotic therapy and training for functional recovery and were followed up for more than 3 years. The short- and long-term efficacies were recorded, and the long-term efficacy was analyzed in patients with different pathological types. Results The long-term efficacy was significantly worse than the short-term efficacy （ 75.0% vs. 90.6% for the satisfactory rate of the efficacy, P 〈 0.05 ）. The long-term efficacy was best in type Ⅳ （ 92.9% ）, followed by type Ⅱ （ 83.3% ） and type Ⅲ （ 75.0% ）, and was worst in type Ⅰ （ 62.5% ）. Conclusions The efficacy of laminectomy with discectomy decreases with time. In the patients with greater prominent nucleus pulposus and less damaged annulus fibrosus, the long-term efficacy is better.