手术与非手术治疗腰椎间盘突出症远期疗效的比较评价

Comparison of long-term outcomes of surgical versus non-surgical treatment to lumbar disc herniation

[目的]评价腰椎间盘突出症患者手术治疗与非手术治疗的远期疗效。[方法]对2000年1月～2002年12月在本院住院治疗的377例腰椎间盘突出症患者进行随访,分析患者手术和非手术治疗前后VAS、ODI的改善情况,同时比较手术和非手术治疗后SF-36生活量表的变化。[结果]共获得有效随访99人,随访率为26.3%。下腰痛VAS评分,手术组(52例)术前:5.84,末次随访:1.78。非手术组(47例)治疗前:6.03,末次随访:2.17,两组治疗前后下腰痛VAS评分有显著差异,但两组疗效间没有显著差异。下肢放射痛VAS评分,手术组(52例)术前:7.45,末次随访:1.52;非手术组(47例)治疗前:5.72,末次随访:2.21,两组治疗前后下肢痛VAS评分有显著差异,两组疗效间有显著差异。Oswestry伤残指数(ODI),手术组(52例)术前:68.18%,末次随访:13.44%;非手术组(47例)治疗前:60.98%,末次随访:17.04%,两组治疗前后ODI有显著差异,两组间没有显著差异。SF-36生存质量调查问卷评分结果显示,治疗后手术组与非手术组相比患者在躯体健康(PF)、躯体角色功能(RP)、躯体疼痛(BP)、生命活力(VT)、情绪角色功能(RE)等5个维度上没有显著性差异(P>0.05);总体健康(GH)、心理健康(MH)和社会功能(SF)手术组较非手术组有显著性差异(P<0.05)。[结论]本组随访资料显示腰椎间盘突出症手术组和非手术治疗组均有较好的远期疗效。手术治疗能更好地缓解腰椎间盘突出症患者的下肢放射痛,对恢复患者的总体健康、心理健康和社会功能也有积极作用。

[Objective]To evaluate the long-term outcomes of surgical treatment versus non-surgical treatment of lumbar disc herniation.[Method]A questionnaire following-up was conducted in 377 patients who underwent surgical treatment versus non-surgical treatment of lumbar disc herniation during 2000-2002 in our institute.Oswestry disability index（ODI） and VAS（low back pain/sciatica） before surgical or nonsurgical treatment and at final follow-up were recorded.SF-36 questionnaire scores were also documented at final follow-up.[Result]Ninety-nine replied questionnaire letters were retrieved with follow-up rate of 26.3%.In the surgery group（52 patients）,low back pain VAS dropped from 5.84 preoperatively to 1.78 at final follow-up,and leg pain VAS dropped from 7.45 preoperatively to 1.52 at final follow-up.In the non-surgical group（47 cases）,low back pain VAS dropped from 6.03 before non-surgical treatment to 2.17 at final follow-up,and leg pain VAS dropped from 5.72 before non-surgical treatment to 2.21 at final follow-up.There were significant differences in low back pain and leg pain VAS between pre-and post treatment,and there were no significant differences in low back pain between the two groups.However,there were significant differences in leg pain between the two groups.ODI of surgical and non-surgical group had significant differences.In the surgery group,ODI dropped from 67.31% to 16.35%.In the non-surgical group,ODI dropped from 68.18% to 13.44%.No significant differences were noted in physical health,physical role function,body pain,vitality and emotional role function between the two groups（P0.05）,while general health,mental health and social function in surgery group had a better outcome than in the non-surgical group（P0.05）.[Conclusion]The follow-up data showed that both the surgery group and the non-surgical treatment group had achieved much better long-term efficacy.However,surgical treatment can relieve leg pain better and improve overall health,mental health and social function.