等离子髓核成形术治疗非特异性腰痛长期随访结果分析

Percutaneous nucleoplasty for non-specific low back pain: long-term follow up results

目的：回顾性分析等离子髓核成形术治疗非特异性腰痛的长期随访结果.方法：2004年9月～2006年12月共治疗非特异性腰痛患者172例,其中获得长期随访者41例.病变部位：L3/4节段7个,L4/5节段38个,L5/S1节段13个；单间隙病变者28例,多间隙病变13例（2间隙病变9例,3间隙病变4例）.所有患者均采用低温等离子髓核成形术进行治疗.分别于术前、术后1周、术后1年、术后3年、术后5年采用患者主观满意度（Macnab标准）,疼痛视觉模拟量表（visual analogue scales,VAS）及Oswestry功能障碍指数（Oswestry disability index,ODI）评分标准进行评定.结果：所有患者手术均顺利完成.1例患者术后发生椎间盘炎,再次入院保守治疗56d后出院.随访60～84个月,平均67个月.术前、术后1周、术后1年、3年及5年VAS评分分别为7.9±0.7分、3.4±0.5分、2.5±0.7分、2.9±0.4分、2.5±0.4分.对应时间点的ODI评分分别为58.9±6.1分、42.1±4.2分、25.8±3.8分、25.4±4.0分、23.0±2.9分；术后1周时优良率为87.9％,术后1年优良率72.4％,术后3年优良率67.7％,末次随访优良率为63.1％,其中单间隙患者优良率81％,多间隙优良率为42％.结论：在诊断明确的前提下,等离子髓核成形术治疗非特异性腰痛在严格把握适应证基础上可获得较为满意的短期、中期临床疗效,长期随访结果显示患者优良率下降.

Objectives：To evaluate the efficacy of percutaneous nucleoplasty for chronic low back pain through a long-term follow-up.Methods：From September 2004 to November 2006,a total of 172 patients suffering from chronic low back pain underwent percutaneous nucleoplasty in our department.41 of 172 cases were followed up for an average of 67 months（range：60-84 months）.A total of 58 levels including L3/4 in 1 patient,L4/5 in 25 patients,L5/S1 in 2 patients,L3/4 and L4/5 in 2 patients,L4/5 and LS/S1 in 7 patients,L3/4,L4/5 and L5/S1 in 4 patients was involved.The outcome was clinically assessed before surgery,1 week,1 year,3 years and 5 years after operation.Visual analogue scale（VAS）,Oswestry disability index（ODI） questionnaire and subjective global rating of overall satisfaction by using modified MacNab criteria （only postoperative） were recorded and analyzed retrospectively.Results：All surgeres were successfully performed,postoperative discitis was noted in 1 case,which was resolved after conservative treatment.The VAS at different time point was 7.9±0.7（pre-operative）,3.4±0.5（1 week post-operative）,2.5±0.7（1 year post-operative）,2.9±0.4（3 years post-operative） and 2.5±0.4（5 years post-operative）,while the ODI score was 58.9±6.1,42.1±4.2,25.8±3.8,25.4±4.0,and 23.0±2.9 respectively at corresponding time point.For both VAS and ODI score,there were significant differences compared with the preoperative,1 week postoperative and 3 years postoperative（P〈0.05） and no significant difference was found between 3 years postoperative and 5 years postoperative.No statistic differences on age,gender,clinical symptoms were noted.Significant differences were found in preoperative disc height,MRI classification of disc degeneration and the results of provocative discography.81% of the patients with 1 level involved showed excellent and good outcome after surgery,while only 42%of the patients with more than 2 levels involved showed the same results.According to the Macnab standard,87.9% of the patients achieved excellent and good outcomes 1 week after surgery,and the rate of excellentand good outcomes were 72.4% at 1 year postoperatively,67.7% at 3 years postoperatively and 63.1% at final follow-up.Conclusions：Percutaneous nucleoplasty generally is safe,effective and simple for the treatment of discogenic low back pain,especially in well selected cases.The results of medium-term and short-term seem to be satisfactory,but there is a significant decline of patients＇ satisfaction after long-term follow-up.