单纯减压术与减压内固定融合术治疗复发性腰椎间盘突出症的疗效比较

Comparison of therapeutic effects between simple decompression and decompression internal fixation fusion for recurrent lumbar disc herniation

目的比较单纯减压术与减压内固定融合术治疗复发性腰椎间盘突出症(RLDH)的疗效。方法选择2017年10月至2021年8月新疆医科大学第六附属医院收治的73例RLDH患者的临床资料,根据患者所接受术式情况分为单纯减压组(31例)和减压内固定融合组(42例)。比较两组手术时间、术中出血量、卧床时间、脑脊液漏发生率,以及术前,术后3 d、3个月、6个月、1年的视觉模拟量表(VAS)评分和Oswestry功能障碍指数(ODI)评分。结果单纯减压组手术时间、卧床时间短于减压内固定融合组,术中出血量少于减压内固定融合组,差异有统计学意义(P<0.05)。两组脑脊液漏发生率比较差异无统计学意义(P>0.05)。两组临床有效率比较差异无统计学意义(74.19%vs 71.43%;χ^(2)=0.069,P=0.793)。两组术后VAS评分、ODI评分均呈下降趋势,与同组术前比较差异有统计学意义(P<0.05),两组各时间点VAS评分、ODI评分比较差异无统计学意义(P>0.05)。结论单纯减压术与减压内固定融合术均可有效治疗RLDH,单纯减压术在缩短手术时间、卧床时间,减少术中出血量方面更具优势。

Objective To compare the therapeutic effects between simple decompression and decompression internal fixation fusion for recurrent lumbar disc herniation(RLDH).Methods The clinical data of 73 patients with RLDH who were admitted to the Sixth Affiliated Hospital of Xinjiang Medical University from October 2017 to August 2021 were selected,and the patients were divided into simple decompression group(31 cases)and decompression internal fixation fusion group(42 cases)according to the surgical procedures they received.The operation time,intraoperative blood loss,bed rest time,incidence of cerebrospinal fluid leakage,and Visual Analogue Scale(VAS)scores and Oswestry disability index(ODI)scores before surgery and 3 days,3 months,6 months and 1 year after surgery were compared between the two groups.Results The operation time and the bed rest time in the simple decompression group were shorter than those in the decompression internal fixation fusion group,and the intraoperative blood loss in the simple decompression group was less than that in the decompression internal fixation fusion group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence of cerebrospinal fluid leakage between the two groups(P>0.05).There was no significant difference in clinical effective rate between the two groups(74.19%vs 71.43%;χ^(2)=0.069,P=0.793).The VAS scores and ODI scores showed a downward trend in the two groups after surgery,and the differences were statistically significant compared with those in the same group before surgery(P<0.05).However,the differences in the VAS scores and ODI scores were not statistically significant between the two groups at each time point(P>0.05).Conclusion Both simple decompression and decompression internal fixation fusion can effectively treat RLDH.Simple decompression has more advantages in shortening the operation time and bed rest time,and in reducing the intraoperative blood loss.