手术和保守治疗腰椎间盘术后椎间盘炎疗效的病例对照研究

Comparison between surgical and conservative treatment for postoperative lumbar discitis

目的:比较手术和保守治疗腰椎间盘术后椎间盘炎的疗效。方法:对2004年1月至2009年1月收治的41例腰椎间盘术后椎间盘炎患者进行回顾性分析,其中男17例,女24例;年龄37～68岁,平均53.6岁。其中手术治疗19例(手术组),保守治疗22例(保守组)。记录患者一般情况、临床特征、影像学资料、实验室检查结果、抗生素使用情况、住院时间、后遗症等,并进行比较分析。临床疗效采用VAS(visual analogue scales,VAS)评分系统和Oswestry功能障碍指数(Oswestry disability index,ODI)进行评定。结果:所有患者均获随访,时间25～40个月,平均31个月。影像学提示植骨融合良好,未出现椎间盘炎复发。与治疗前相比,治疗后1个月、1年及2年VAS评分及ODI指数均有明显改善(P<0.01);组间比较,1个月时手术组VAS及ODI优于保守治疗组(P<0.01),治疗后1年及2年时这2项指标间的差异无统计学意义(P>0.05)。结论:椎间盘术后并发椎间盘炎,需积极治疗,保守治疗和手术治疗均是有效的治疗方法。短期内手术疗效优于保守治疗,但长期随访显示保守治疗也可达到满意疗效。

Objective： To compare therapeutic effects between surgical and conservative treatment for postoperative lum- bar discitis. Methods：From January 2004 to January 2009,41 patients （17 males and 24 females ranging the age from 37 to 68 years with an average of 53.6 years） with postoperative lumbar discitis were retrospectively studied and divided into two groups. There were 19 patients in operation group, 22 patients in conservative group. Clinical data and features, image data, laboratory examinations, antibiotics utilization, hospital stays and sequelae were recorded and analyzed. Visual analogue scales system （VAS） and Oswestry disability index （ODI） were applied to evaluate therapeutic effects. Results：All patients were fol- lowed up over 2 years. Imaging revealed good bone fusion and no occurrence of discitis. VAS score and ODI at 1 month, 1 year and 2 years were significantly improved after treatment （P〈0.01）. While VAS and ODI in operation group at 1 month were im- proved more than that of conservative group （P〈0.01）, and there was no significant difference between two groups at 1 year and 2 years （P〉0.01）.Conclusion：Surgical and conservative treatment for postoperative lumbar discitis is effective. Surgical treat- ment is superior to conservative treatment in a short time ,while conservative treatment can achieve long-term satisfactory cura- tive effects.