腰椎间盘突出症手术后疗效不佳的原因

Causes of unsatisfied curative effect of operation on lumbar disc herniation

目的 探讨后路髓核摘除术手术疗效及其适应证。方法 采用CTM对突出物的尖锐度进行测量 ,分析腰椎节段性不稳对手术疗效的影响。参照JOA标准对 2 86例患者自觉症状、临床检查的改善程度进行术前、术后对照比较。结果 2 9例术后疗效不佳 (10 1% )。其中 ,Ⅰ组 :自觉症状改善不足 5 0 % ,12例 ;Ⅱ组 :临床检查改善率不足 2 5 % ,11例 ;Ⅲ组 :神经根症状加重 ,6例。结论 髓核摘除手术的最佳适应证应具备 3个条件 :①主诉为坐骨神经痛 ;②无节段性腰椎不稳 ;③突出物的尖锐度 >30°。

Objective To investigate the curative effect and indications of operation on lumbar disc herniation. Methods The sharp degree of lumbar disc herniation with CTM was measured and the influence of unsteadiness of segmental lumbar upon operative curative effect of 286 patients were analysed by JOAs standard: compared symptom and clinical examination on preoperation and postoperation. Results 29 cases (10 1%) had poor results. In group Ⅰ 12 cases (50%) had improved symptom. In group Ⅱ 11 cases(<25%) showed improvement on clinical examination. In group Ⅲ 6 cases had exacerbated symptom. Conclusion The best indication for operation on prolapse of lumbar intervertebral disc must have three conditions: ①cases complaint has sciatica; ②no segmental lumbar vertebral unsteadiness; ③ sharp degree of prolapse of lumbar intervertebral disc must be>30°.