巨大破裂型腰椎间盘突出症重吸收30例随访研究

Resorption of massive ruptured lumbar disc herniation:a follow-up study on 30 cases

[目的]探讨巨大破裂型腰椎间盘突出症经非手术治疗发生重吸收后的临床疗效。[方法]对本院2012年3月～2016年5月因巨大破裂型腰椎间盘突出症行非手术治疗后发生重吸收并获得2年以上随访的30例患者进行回顾性分析。其中男性19例,女性11例;年龄20～58岁,平均(39.17±8.60)岁;病程5 d～6个月,平均(38.63±33.37)d。所有患者均行非手术治疗,初诊和末次随访分别采用JOA下腰痛评分,测量MRI突出率、MRI突出物体积、MRI突出物最大面积占椎管面积比值评价临床疗效。[结果]30例患者经非手术治疗,临床症状完全缓解。JOA下腰痛评分由初诊时(9.97±3.50)分增加至末次随访时(25.00±1.67)分,差异有统计学意义(P<0.05)。MRI影像测量表明,突出率由初诊(84.72±10.54)%减少至末次随访时(18.50±6.46)%,突出物体积由(2 389.35±712.82)mm^3减少至(512.58±305.21)mm^3,MRI突出物最大面积占椎管面积比值由(41.56±10.60)%减少至(13.02±4.64)%,上述3项指标两时间点的差异均有统计学意义(P<0.05)。末次随访时突出物吸收率为(77.78±8.43)%,与初诊时牛眼征边缘信号平均宽度值呈显著正相关(r=0.564,P<0.001)。[结论]2年以上的随访证实巨大破裂型腰椎间盘突出症经非手术治疗发生重吸收后临床症状及影像学表现显著改善,疗效良好。

[Objective] To investigate the clinical consequences of resorption of massive ruptured lumbar disc herniation after non-surgical treatment. [Methods] A retrospective study was conducted on 30 patients who got resorption of herniated disc after non-surgical treatment for massive ruptured lumbar disc herniation between March 2012 and May 2016, and followed up for more than 2 years. The 30 patients, including 19 males and 11 females, aged from 20 to 58 years with an average of（39.17±8.60） years, and took course of disease from 5 days to 6 months with a mean of（38.63±33.37） days. The Japanese Orthopedic Association（JOA） score and MRI measurements, such as protrusion rate, protrusion volume and the ratio of the maximum area of protrusion to total canal area, was compared between the first visit and the latest follow up for evaluation of clinical outcomes.[Results] All the 30 patients got complete relief of the clinical symptoms after non-surgical treatment. The JOA significantly increased from（9.97±3.50） at the first visit to（25.00±1.67） at the latest follow up（P〈0.05）. In term of MRI measures, the protrusion rate significantly decreased from（84.72±10.54）% to（18.50±6.46）%（P〈0.05）, whereas the protrusion volume significantly decreased from（2389.35±712.82） mm^3 to（512.58±305.21） mm^3（P〈0.05）, and the ratio of the maximum area of protrusion to total canal area significantly decreased from（41.56±10.60）% at the first visit to（13.02±4.64）% at the latest follow up（P〈0.05）.The resorption rate of herniated disc at the latest follow up proved（77.78±8.43）%, which was positively correlated to the average edge width of bull eye sign（r=0.564, P〈0.001）. [Conclusion] This more than 2 years follow-up study demonstrates that massive ruptured lumbar disc herniation might be resorbed after non-surgical treatment, which achieves satisfactory clinical outcomes with significantly clinical and imaging improvements.