循证干预原则用于退变性腰腿痛再手术的术式选择

Evidence-based intervention principle in selection of reoperation method in degenerative lumbocrural pain

目的探讨应用循证干预原则选择退变性腰腿痛再手术的术式及其临床疗效。方法应用循证干预原则,根据退变性腰腿痛再手术的成因,结合患者年龄、身体状况与职业需求等因素,对12年来172例退变性腰腿痛再手术患者实施各类术式:其中椎间孔镜19例;开窗式突出物摘除22例;后路减压单枚Cage融合40例;后路减压单边固定Cage融合54例;后路减压双侧固定Cage融合38例。通过观察近期直腿抬高实验、临床疗效、椎间融合等指标评价术后疗效。结果 144例直腿抬高术前受限者术后明显改善。临床总疗效:优102例(53.30%),良56例(32.59%),可14例(8.14%),差0例。132例施行椎间融合病例中,已融合106例,可能融合26例,无一例未融合。结论退变性腰腿痛再手术过程中并非一味强调扩大减压、固定融合,具体应遵循循证干预原则个性化地合理选择相应术式以获得满意疗效。

Objective To discuss the selection of reoperation method in degenerative lum- bocrural pain by evidence-based intervention principle and its clinical effects. Methods 172 patients with degenerative lumbocrural pain were reoperated by several methods in 12 years ac- cording to the cause of the pain, the age of the patients, physical conditions and the needs of their work. Straight-leg raising test, clinical effect and intervertebral fusion were used to evaluate the curative effect after operations. Results The symptom of 144 patients whose straight-leg raising tests were positive before operation got relieved significantly. The excellent and good rate was 91.8%. Of 132 cases who underwent the operation of intervertebral fusion, union had been confirmed in 106 cases, possible union was found in 26 cases, nonunion was not found. Con- dusion Evidence-based intervention principle should be used in reoperation of degenerative lumbocrural pain, and to choose the proper operation method individually.