非手术治疗巨大型腰椎间盘突出症的临床研究现状

Clinical Studies of Non-surgical Treatment for Giant Lumbar Disc Herniation:A Review

巨大型腰椎间盘症(GLDH)作为腰椎间盘突出中较为严重的一种类型,目前临床大多采用手术治疗,而手术疗法目前存在着神经损伤、术后并发症等诸多困扰。随着医学影像技术的普及,研究发现腰椎间盘突出后若未经手术干预会出现髓核自行回纳或减小的现象,没有出现明显神经损害的GLDH患者经过非手术治疗可以在改善临床症状的同时促进突出物的重吸收,可使患者免于承受手术的风险与负担,为其提供了更多治疗选择。中医药疗法治疗本病具有突出优势与特色,可显著改善患者临床症状、促进突出物的减少。但目前对于如何预测突出物是否会发生重吸收以及非手术疗法的选择、预后判断等问题尚无定论,且各种非手术疗法缺少更高级别的循证研究以验证其疗效。

Giant lumbar disc herniation(GLDH),a serious type of lumbar disc herniation,is mostly treated with surgery in clinical practice.However,surgical treatment faces problems such as nerve injury and postoperative complications.With the popularization of medical imaging,studies have discovered that without surgical intervention,the nucleus pulposus will retract or decrease automatically after lumbar disc herniation.The non-surgical treatment can alleviate the clinical symptoms while promoting the resorption of protrusions in the GLDH patients who do not have obvious neurological damage,serving as a treatment option avoiding the patients′risks and burdens of surgery.Chinese medical therapies capable of relieving symptoms and promoting the reabsorption of protrusions demonstrate outstanding advantages and unique characteristics in treating this disease.However,there is no consensus on the prediction of whether protrusions will undergo reabsorption,as well as on the selection and prognosis of non-surgical therapies.Moreover,there is a lack of higher-level evidence-based research to verify the efficacy of non-surgical therapies.