后路髓核摘除结合弹性棒内固定治疗腰椎间盘突出症的临床研究

Clinical study of discectomy combined with K-rod dynamic internal fixation for lumbar disc protrusion

目的评价后路小开窗髓核摘除结合弹性棒内固定治疗腰椎间盘突出症的效果。方法将36例腰椎间盘突出症分为A组(16例)和B组(20例),A组行后路小开窗髓核摘除结合弹性棒内固定术,B组行单纯后路小开窗髓核摘除术,随访分析患者疗效和并发症,测量和比较手术前后患者ODI、VAS和椎体间高度、角度和MRI T1值。结果所有患者获12个月以上随访,无严重并发症发生。A组疗效优良率为93.8%,B组疗效优良率为90.0%。两组术后1年腰痛VAS、下肢放射痛VAS和ODI均较术前明显减少(P<0.01),手术上下节段的椎间高度、运动范围、髓核MRI T1值较术前均无明显变化(P>0.05)。术后1年手术节段较术前:A组运动范围明显减少(P<0.05)、椎间高度增加(P<0.05)和髓核MRI T1值增加(P<0.05),B组均无明显变化(P>0.05)。A组较B组术后1年手术节段运动范围减少(P<0.05)、椎间高度增加(P<0.05)和髓核MRI T1值增加(P<0.05)。结论后路小开窗髓核摘除结合弹性棒内固定治疗腰椎间盘突出症可达到满意疗效,近期不会导致邻近节段退变,可能有利于手术节段髓核修复。

Objective To evaluate the short-term results of discectomy combined with K-red dynamic internal fixation for lumbar disc protrusion. Methods Between September 2010 and November 2011, 36 cases of single segment lumbar disc protrusion were randomly surgically treated by discectomy combined with K-rod dynamic internal fixation （16 eases, group A） and single discectomy （20 cases, group B）, respectively. The preoperative and 1 year postoperative functional evaluation were graded with ODI and VAS scoring system. The height, range of motion and MRI T1 value of the intervertebral disc and adjacent segments intervertebral （upper and lower segments） discs were measured as well. Statistical analyses included mean values, 95% confidence intervals. Results The back and leg pain VAS scores and ODI decreased significantly after operation （P 〈0.01）, the differences in the height , range of motion and MRI T1 value of the adjacent segments intervertebral discs were not significant （P 〉0.05） between group A and group B. Compared with those before operation, the postoperative height increased signifieantly（P 〈0.05）, the range of motion declined significantly（P 〈0.05） and MRI T1 value increased significantly （P 〈0.05） at the operative intervertebral disc in group A, and those were not significant （P 〉0.05） in group B. Conclusion Diseectomy combined with K-rod dynamic internal fixation could achieve satisfactory clinical and radiographic results for the lumbar disc protrusion, could not accelerate the degeneration of the adjacent segments and maybe could help the disc repairing process in short-term.