腰椎间盘内破裂的诊断和治疗

The diagnosis and treatment of lumbar internal disc disruption

目的 研究腰椎间盘内破裂的诊断和治疗方法。 方法 36例慢性失能性下腰痛病人 ,经腰椎间盘造影术证实为腰椎间盘内破裂 ,选择腰椎体间融合术 ,其中 8例行后路椎体间植骨融合椎弓根螺钉系统内固定术 (PLIF) ,2 8例行前路髓核摘除植骨融合术 (ALIF)。分别于术前、术后对病人的腰痛情况进行视觉疼痛自我评定尺 (VAS)评分 ,同时评估术后腰椎融合率。 结果 术后随访时间 6～ 2 6个月 ,平均 18个月。 8例行PLIF者 ,6例术后腰腿痛症状基本消失 ,2例仍有轻度腰痛 ,术前、术后VAS腰痛评分 ,差异有非常显著性意义 (P <0 0 1)。 2 8例行ALIF者 ,2 7例腰腿痛症状基本消失 ,术前、术后VAS腰痛评分 ,有非常显著性差异 (P <0 0 1)。行PLIF患者 ,融合率为 88% ,行ALIF者 ,融合率达 97%。 结论 腰椎椎体间融合术是治疗腰椎间盘内破裂的有效方法 。

Objective To study the diagnosis and treatment of lumbar internal disc disruption(IDD). Methods Thirty six patients with chronic disabling low back pain proved by discography as IDD were treated with disc excision and lumbar interbody fusion, and 8 cases were treated with PLIF, 28 with ALIF. The clinical results were evaluated by pre and post operative VAS, and the fusion results were evaluated by X ray studies of the lumbosacral spine. Results The average period of follow up was 18 months, ranging from 6 to 26 months. Six patients treated with PLIF basically disappeared low back pain, 2 complained of mild back pain; the VAS after operation was decreased significantly in comparison with that of preoperation ( P <0 01). Twenty seven treated with ALIF basically disappeared low back pain; the VAS after operation was decreased significantly in comparison with that of preoperation ( P <0 01). Fusion rate was 88% in patients who were treated with PLIF, and 97% in patients with ALIF. Conclusion Disc excision and interbody fusion is an effective method for the treatment of IDD, but the operation indications should be known well.