椎板开窗髓核摘除术治疗腰椎间盘突出症10年以上随访的疗效评价

Laminectomy and extraction of nucleus pulposus for treatment of lumbar disc herniation:effect evaluation of over 10-year-followed-up

目的:通过对143例获得10年以上长期随访的单节段椎板开窗减压髓核摘除术后的腰椎间盘突出症患者进行回顾性分析,了解其随访时的临床疗效、复发率,并判断不同年龄段患者,不同椎间盘突出严重程度患者的随访结果是否存在差异。方法:143例患者均获得随访(手术时间1996年1月至2000年12月),其中男80例,女63例;患者手术时年龄18～66岁,平均37.85岁;随访时间10～15年,平均12.7年。按照手术时年龄将患者分为30岁以下,30～50岁,50岁以上3组分别进行疗效评价;所有获得随访的患者中87例收集到了术前的CT扫描结果,根据CT测量椎间盘突出的严重程度将87例患者分为Ⅰ、Ⅱ、Ⅲ度共3组进行疗效评价。2011年对所有患者行末次随访,选择JOA评分和ODI指数评价其总体手术效果和各组间疗效有无差异,使用改良Macnab标准对患者进行评价。结果:①143例患者术前JOA评分为5.11±2.02,末次随访为12.51±2.35;术前ODI评分为33.98±7.42,末次随访为13.39±6.79,末次随访时JOA与ODI评分与术前相比差异均有统计学意义(P<0.01)。按照改良Macnab标准优良率达到了83.2%(119/143),复发率为6.3%。②30岁以下组与其他年龄组相比术后JOA评分差异有统计学意义,其余两组间JOA评分差异无统计学意义;各组间ODI评分差异无统计学意义。③椎间盘突出Ⅲ度的患者术后JOA和ODI评分与其他两组差异有统计学意义,其余两组间差异无统计学意义。结论:①长期随访证实单节段椎板开窗减压髓核摘除术治疗腰椎间盘突出症远期疗效良好,复发率低,是多数该病患者的首选手术方法;②青年患者(30岁以下)施行该手术后部分患者51%(19/37)会有经常出现的腰背痛;③椎间盘突出程度严重的患者行单纯椎板开窗减压术远期疗效差于相对轻度突出的患者。

Objective：To investigate retrospectively the clinical effects and recurrence rate of 143 cases who underwent one level discectomy and followed up more than 10 years. To evaluate the outcome of patients in groups of different operating age and extents of disc herniation, and analyse whether difference exists in each group. Methods：There were 143 patients （operation time from January 1996 to December 2000） including 80 males and 63 females,aged from 18 to 66 years old with an average of 37.85 years. The followed-up time was 10 to 15 years with an average of 12.7 years. Patients were divided into 3 groups depends on operating age〈30 years old, 30 to 50 years old and 〉50 years old; 87 patients who＇s pre-operative CT scan could be collected among 143 cases were divided into 3 groups depends on extents of disc herniation： I °, Ⅱ°and Ⅲ°. The final followed-up was obtained in 2011 ,to evaluate each group and the holistic clincal outcome with JOA scores and ODI scores, and observe whether there were difference between every groups; to judge the effects by patient himself with modified Macnab Criteria. Results ：JOA scores preperation and final followed-up was 5.11 ±2.02 and 12.51 ±2.35 respectively; ODI scores pre-operation and final followed-up was 33.98±7.42 and 13.39±6.79 respectively. There were significant differences between pre-operative and final followed-up in JOA and ODI （P〈0.01）. The excellent-good rate was 83.2% （119/143）according to modified Macnab Classification with recurrence rate of 6.3% at final follow-up. Obvious difference was found in JOA scores in group who＇s age at operation less than 30 years old compared with other 2 groups at followed-up time, and no significant difference was found in JOA scores between other two groups ; no significant difference was found in ODI scores among the three groups. Significant difference was found in JOA and ODI scores in group with III lumbar disc herniation group com- pared with other 2 groups, and no statistical difference was found in clincal scores between other 2 groups. Conclusion： Long -term followed-up of 143 cases prove mono-level lumbar discectomy is an option for disc herniation with good curative effectand lower recurrent rate,the technique should be the prior selection in dealing with patients with lumbar disc herniation. 51% patients （ 19/37 ） in group under 30 years old endure persistent low back pain. The long-term clinical effects in patients with severe disc protrntion who underwent lumbar discectomy is worse than those patients with mild lumbar disc herniation