有限髓核摘除结合纤维环缝合治疗腰椎椎间盘突出症的早期疗效

Early treatment response of finite lumbar discectomy combined with annulus fibrosus suture for lumbar intervertebral disc herniation

目的观察有限髓核摘除结合纤维环缝合治疗腰椎椎间盘突出症的早期临床疗效。方法对2015年1月—2016年3月在本院行有限髓核摘除术的59例腰椎椎间盘突出症患者临床资料进行回顾性对照研究。缝合组28例行小切口腰椎椎板开窗有限髓核摘除结合纤维环缝合术;对照组31例行小切口腰椎椎板开窗有限髓核摘除,未行纤维环缝合。采用MacNab标准对术后1、3、6个月的治疗效果进行评价,同时采用椎间盘高度及椎间盘夹角对术后6个月时的脊柱稳定性进行评价。结果术后1、3个月2组Mac Nab评分优良率比较差异无统计学意义;术后6个月时缝合组患者优良率高于对照组,差异有统计学意义(P<0.05)。术后6个月时缝合组患者椎间盘高度高于对照组,差异有统计学意义(P<0.05),椎间盘夹角小于对照组,差异有统计学意义(P<0.05)。随访6个月无复发及再手术患者。结论有限髓核摘除结合纤维环缝合术治疗腰椎椎间盘突出症安全、可靠,能获得满意的早期临床疗效且不影响脊柱稳定性,是降低复发率和再手术风险的一种行之有效的方法,值得临床推广应用。

Objective To observe the early clinical efficacy of finite discectomy combined with annulus fibrosus repair in the treatment of lumbar disc herniation.Methods From January2015to March2016,59patients who underwent finite discectomy caused by lumbar disc herniation were retrospectively analyzed.The28out of the59patients received annulus fibrosus suture as the treatment group,while another31patients without suture as the control group.Then evaluation indexes included surgery time,bleeding volume,complication,length of stay.MacNab criteria was used to evaluate improvement of the functional status at postoperative1,3,6months.Intervertebral disc height and angle were used to evaluate and compare the postoperative spinal stability between the2groups at postoperative6months.Results There was no significant difference in MacNab criteria between the2groups at postoperative1and3months.At postoperative6moths,MacNab criteria of treatment group was significantly superior to that of control group,and the difference was statistically significant P<0.05).Meanwhile,intervertebral disc height of treatment group was higher than that of control group,and the difference was statistically significant P<0.05).The intervertebral disc angle is smaller than that of control group,and the difference was statistically significant(P<0.05).No recurrence and no re-operation happened in the near future.Conclusion Finite lumbar discectomy combined with annulus fibrosus suture in the treatment of lumbar disc herniation is safe and reliable,and can lead to satisfactory early clinical efficacy and do not affect the stability of the spine.In addition,it is an effective method for reducing the risk of recurrence and re-operation,and being worthy of clinical wider application.