单纯椎板开窗髓核摘除术与椎板开窗髓核摘除纤维环缝合术治疗未成年人腰椎间盘突出症疗效比较

Comparison of the effect between fenestration discectomy associated with annulus repair and fenestration discectomy in the treatment of lubar intervertebral disc protrusion in underage patients

目的比较单纯椎板开窗髓核摘除术与椎板开窗髓核摘除纤维环缝合术治疗未成年人腰椎间盘突出症(LIDP)的临床效果。方法选择2013年5月至2016年5月固始县人民医院收治的LIDP未成年患者86例,根据手术方式分为A组(47例)和B组(39例),A组患者采取单纯椎板开窗髓核摘除术治疗,B组患者采取椎板开窗髓核摘除纤维环缝合术治疗。比较2组患者切口长度、术中出血量、手术时间及术后住院时间;术后随访6个月,对2组患者腰椎功能日本骨科学会(JOA)评分、临床疗效及并发症发生率进行比较。结果 2组患者切口长度、术中出血量、手术时间及术后住院时间比较差异均无统计学意义(P>0.05)。术后6个月,A、B组患者腰椎功能JOA评分优良率分别为61.70%(29/47)、92.31%(36/39),B组患者腰椎功能JOA评分优良率显著高于A组(χ~2=12.173,P<0.05)。A、B组患者治疗总有效率分别为77.27%(34/47)、97.44%(38/39),B组患者治疗总有效率显著高于A组(χ~2=11.537,P<0.05)。A组患者复发率和并发症发生率分别为21.28%(10/47)、10.64%(5/47),B组患者复发率和并发症发生率分别为7.69%(3/39)、5.13%(2/39),B组患者复发率和并发症发生率均显著低于A组(χ~2=4.231、4.756,P<0.05)。结论单纯椎板开窗髓核摘除术与椎板开窗髓核摘除纤维环缝合术治疗未成年人LIDP均有显著效果,但椎板开窗髓核摘除纤维环缝合术可以更好地改善LIDP患者的腰椎功能,提高治疗效果,降低复发率和并发症发生率。

Objective To compare the therapeutic effect between fenestration discectomy associated with annulus repair and fenestration discectomy in the treatment of lubar intervertebral disc protrusion （LIDP） in underage patients.Methods Eighty-six underage LIDP patients in the People＆#39;s Hospital of Gushi County from May 2013 to May 2016 were selected and divided into group A（n =47）and group B （n =39）according to surgical method.The patients in group A were treated with fenestration discectomy,while the patients in group B were treated with fenestration discectomy associated with annulus repair.The length of incision,intraoperative bleeding volume,operation time and postoperative hospitalization time were compared between the two groups.The patients were followed up for six months,and the Japanese orthopaedics association （JOA）score of lumbar function,clinical effect and the incidence of complications were compared between the two groups.Results There was no significant difference in the length of incision,intraoperative bleeding volume,operation time and postoperative hospitalization time between the two groups（P 〉 0.05）.Six months after operation,the fineness rate of JOA score of lumbar function in group A and group B was 61.70% （29/47）and 92.31% （36/39）respectively,the fineness rate of JOA score in group B was significantly higher than that in group A（x2 =12.173,P 〈 0.05）.The total effective rate of group A and group B was 77.27% （34/47） and 97.44% （38/39） respectively,the total effective rate in group B was significantly higher than that in group A （x2 =11.537,P〈0.05）.The recurrence rate and the incidence of complications in group A were 21.28% （10/47） and 10.64% （5/47）,and they were 7.69% （3/39） and 5.13% （2/39） in group B,the recurrence rate and the incidence of complications in group B were significantly lower than those in group A （x2 =4.231,4.756;P 〈 0.05）.Conclusion The fenestration discectomy associated with annulus repair and fenestration discectomy in the treatment of LIDP in underage patients have significant effect.But the fenestration discectomy associated with annulus repair can better improve the lumbar function and treatment effect,and reduce the recurrence rate and the incidence of complications in underage patients with LIDP.