开窗髓核摘除术治疗腰椎间盘突出症的不同病理分型的疗效观察

Curative effect observation on fenestration discectomy for lumbar disc herniation with different pathological types

目的 探讨开窗髓核摘除术治疗腰椎间盘突出症的不同病理分型的疗效.方法 回顾性分析经后路椎板开窗髓核摘除术治疗98例腰椎间盘突出症患者,根据术中所见椎间盘突出的髓核形态及纤维环破损大小将其分为四型,并对各型进行术后3个月疗效观察,并进行统计学分析比较.结果 术前术后JOA评分显示下腰背痛、腿痛和/或麻刺痛、步态、日常活动受限度及总分的改善各分型都有显著的统计学差异（P＜0.01）;下腰背痛和直腿抬高试验,除Ⅰ型外,其它各型术前术后比较均有统计学差异（P＜0.01）;感觉、运动及膀胱功能方面,除Ⅳ型外,其它各型术前术后比较均无统计学差异（P＞0.05）.手术后,各型VAS评分显著低于术前（P＜0.01）.根据SC标准,疗效优劣依次为Ⅳ型、Ⅱ型、Ⅲ型、Ⅰ型.结论 腰椎间盘突出症患者在采用开窗髓核摘除术后患者的下腰背痛、步态、腿痛和/或麻刺痛及总分改善各分型等方面均较明显改善,有较好临床疗效.开窗髓核摘除术治疗腰椎间盘突出症的预后跟术前椎间盘的纤维环的完整性密切相关.

Objective To explore the effect of discectomy for different pathological typings of lumbar disc herniations.Methods 98 patients with lumbar disc herniations treated by discectomy were retrospectively analyzed.They were divided into four types by the nucleus pulposus shape and the size of fibrous rings breakage in the intraoperative findings,and to explore the effect of every type after 3 months.All results were analyzed statistically.Results Preoperative and postoperative JOA scores showed that backache,skelalgia,gait,daily activity limitation and the total scores were significantly different in all types （P ＜ 0.01）.Except for type Ⅰ,backache and straight-leg raising test got significant differences in all types （P ＜ 0.01）.Except for type Ⅳ,sensory,motility and bladder dysfunction were not significantly different in all types （P ＞0.05）.Postoperative VAS scores of each type were significantly lower than preoperative VAS scores （P ＜ 0.01）.The therapeutic effects were ranked by SC criterion such as type Ⅳ ＞type]Ⅱ ＞type Ⅲ ＞type Ⅰ.Conclusion After fenestration discectomy,backache,gait,skelalgia and the total scores of patients with lumbar disc herniation significantly improved,with good clinical effect.Prognosis was related to preoperative completeness of annulus fibrosus of intervertebral disc.