髓核摘除联合纤维环缝合治疗腰椎间盘突出症的早期疗效观察

The early clinical effects of lumbar discectomy associated with annulus repair in the treatment of lumbar disc herniation

目的探讨髓核摘除联合纤维环缝合治疗单纯腰椎间盘突出症的早期临床疗效。方法收集自2014年1月至2015年9月，单纯腰椎间盘突出症接受髓核摘除手术者56例，按随机数字表法分为单纯髓核组（28例）及纤维环缝合组（28例）。记录两组切口长度、手术时间、术中出血量、住院时间及术后并发症，比较两组手术前后下肢疼痛视觉模拟评分（VAS）、Oswestry功能障碍指数评分（ODI）、Macnab标准疗效评定及末次随访时腰椎间盘突出症复发情况。结果所有患者均获随访，随访时间12-18（14．5±1．3）个月。两组在切口长度、术中出血量、住院时间比较差异无统计学意义（P〉0．05）；纤维环缝合组手术时间长于单纯髓核组，但差异无统计学意义（P〉0．05）；两组术后VAS、ODI评分与术前比较差异有统计学意义（P〈0．05），纤维环缝合组术后24h及术后3dVAS评分低于单纯髓核组（P〈0．05）。纤维环缝合组疗效优良率稍高于单纯髓核组，但差异无统计学意义（P〉0．05）。纤维环缝合组无术后复发病例，单纯髓核组有2例复发，两组间比较差异无统计学意义（P〉0．05）。结论对于单纯腰椎间盘突出症，髓核摘除术联合纤维环缝合治疗安全有效，可获得更好的早期疼痛缓解，有效降低腰椎间盘突出症复发率。

Objective To explore the early clinical effects of lumbar discectomy associated with annulus repair in the treatment of lumbar disc herniation. Methods A prospective study was conducted to review 56 patients with lumbar disc herniation who accepted discectomy surgery in Subei Peopleg Hospital of Jiangsu Province from January 2014 to September 2015, including 28 cases of discectomy associated with annulus repair （repair group） and 28 cases of discectomy （control group）. Oswestry disability index and visual analog scale scores were recorded. Simuhaneously, incision length, operative time, blood loss, hos- pitalization time, surgical complications, and postoperative recurrence of lumbar disc herniation were recor- ded. Results All patients completed the follow-up for 12 to 18 months （ 14. 5 -＋ 1.3 ）. There was no differ- ence between the repair and control groups in the incision length, blood loss and hospitalization time （ P 〉 0. 05）. The operative time of the repair group was longer than that of the control group, but the difference was not statistically significant （ P 〉 0. 05 ）. The Oswestry disability index and visual analog scale scores for lumbar and lower limb pain significantly decreased in both groups after surgery （ P 〈 0. 05 ）. The visual ana- log scale scores at 24 hours and 3 days after surgery in the repair group were less than that in the control group （ P 〈 0. 05 ）. The satisfactory rate of treatment in the repair group was slightly higher than that in the control group, but the difference was not statistically significant （ P 〉 0. 05 ）. There was no recurrence in the repair group, but 2 recurrence cases in the control group （ P 〉 0. 05 ）. Conclusions These findings indicate that discectomy associated with annulus repair is a safe and reliable method to obtain remarkable early clinical results and can reduce the recurrent rate in the treatment of lumbar disc herniation.