多节段腰椎间盘突出症的治疗

Treatment of multiple level lumbar disc protrusion

目的探讨多节段腰椎间盘突出症治疗中的特点。方法自2002年1月至2010年6月首都医科大学附属北京朝阳医院骨科共收治68例多节段腰椎间盘突出症的患者,其中男性42例,女性26例,年龄在30～78岁,平均年龄(51±12)岁,病人病程在1～15年,平均(3±1)年。本组患者中,58例选择后路手术,其中开窗或半椎板减压单纯髓核摘除术33例68个椎间隙(双侧7例,单侧26例),后路减压同时椎弓根螺钉内固定植骨融合手术25例54个椎间隙;10例20个椎间隙选择前路人工椎间盘置换手术。结果术后随访1～9年,平均46个月,使用非参数检验,不依赖于总体分布,即不考虑是否正态分布的秩和检验,术前JOA评分6～17分,平均(9.6±2.0)分,术后JOA评分20～29分,平均(24±2.0)分,统计量Z=-7.276,双侧概率,与术前比较P<0.01,差异有统计学意义;术前VAS评分6～10分,平均(8.2±1.0)分,术后VAS评分0～3分,平均(1.4±1.0)分,统计量Z=-7.210,双侧概率P<0.01,与术前比较差异有统计学意义。不同手术方式之间JOA评分和VAS评分差异无统计学意义。患者均恢复了以前的工作和日常生活,对手术治疗的满意度为60%～95%,平均86%。结论多节段腰椎间盘突出治疗的关键是正确选择导致疼痛的椎间盘。椎间盘造影术可以帮助骨科医师准确选择多节段腰椎间盘突出治疗部位。

To study the characteristic of multi-level lumbar disc protrusion treatment. Methods 68 patients who suffered from multi-level lumbar disc protrusion were reviewed retrospectively from Jan 2002 to Jun 2010. male： 42, femaie： 26. age： 30 - 78, average： 51±12, history： 1-15 years, average： 3±1 years. 58 patients（33 patients, 68 discs） accept posterior disectomy（double side： 7, single side： 26） ; 25 patients with 54 disc underwent spinal fusion; 10 patients 20 discs underwent artificial disc replacement. Results All patients were followed up for 1 to 9 years （mean 46 months ）. The average preoperative JOA was 9.6 ~ 2.0 （range： 6 to 17 ）, while postoperative JOA was 24＋2.0（range： 20 to 29）. The Chi-square test, Z=-7. 276, P〈0. 01, indicate the significant difference. The average preoperative VAS was 8.2~1.0（ range： 6 to 10）, while postoperative VAS was 1.4±1.0（ range： 0 to 2）. The Chi-square test, Z= -7.210, P〈0.01, indicate the significant difference. Conclusion To define the ＂pain-relative disc＂ take important role in multi-level lumbar disc protrusion treatment, and discography take an important role in operative segmental selection in multi-level lumbar disc protrusion.