手术辅以规则康复训练治疗腰椎间盘突出症长期随访研究

A long-term follow-up study for treatment of in tervertebral disc herniation with rehabilitative methods

目的:随访10年以上的经腰椎板减压髓核摘除,术后给予规则的康复治疗及指导的腰椎间盘突出症患者进行回顾性研究,为临床腰椎间盘突出症的治疗提供可靠的参考。方法:筛选10年以前住院治疗的腰椎间盘突出症患者,且10年来一直进行随诊并居住在北京,病历及影像学资料完整,随访时能配合的患者作为研究对象,平均随访年限为26年,观察经腰椎板减压髓核摘除辅以规则康复训练10年以上的结果,影像学改变,测量突出间隙手术前与现在的椎间隙高度值并对其进行统计学分析,观察相邻的上下椎间隙的退行性变情况。结果:140例全椎板或部分椎板切除髓核摘除患者,112例患者可正常生活和工作,12例患者分别于术后第2～10年时因椎间盘突出复发行再次椎间盘手术,本组椎间隙平均降低(5.50±1.51)mm,15例患者出现邻近间隙的退行性变。结论:经腰椎管减压髓核摘除辅以康复训练的腰椎间盘突出症患者,远期疗效良好;手术间隙出现狭窄的时间较早、程度较重,相邻间隙较少发生退行性变,脊柱的稳定性受影响较小;手术时应尽量保留椎小关节的完整性,并保留相对正常的髓核组织;规则的康复训练是有效的辅助治疗方法。

AIM:To observe a long-term follow-up re su lts of clinical situation and imaging changes of lumbar intervertebral disc hern iation treatment,an d to provide an objective evaluation of t he results of sim ple rehabilitative thera-pies.METHODS:The definite lumbar intervertebral disc herniation cases,who were treated in in-patient and out-p atient department ten years ago,and strictly followed up in our hospital in recent ten years,we re carefully s elected for this study.They were all very coo perative and Beiji ng residents.The fol-low-up duration for the patients was10-38years(ave rage 26years).One hundred and eighty cases in this grou p,156males and 24females.The long term therapeutic effects and image c hange were observed. The height diff er-ence of intervertebral space in the p rotruded space was mea sured before treatment and the latest follow-up.And degeneration of the two in tervertebral spaces adjacent to the protruded int ervertebral space was also obs erved.RESULTS:Among the 140cases in this group,the effect was quite good i n161cases and the patients undertook almost normal life and work,vertebr al canal decompression was performed 2-10years later respectively for the rest 12cases because of intermitten t claudication.The protruded interverte-bral space was decreased(5.50±1.51)mm averagely in height after regular re habilitative treatment.The adja cent intervertebral space degenera tion was obs erved in 15cases.The effect of lumbar intervertebral disc hernia tion treated by simple rehabilitative therapy is good after a long-term follow -up observa-tion if the indication is chosen prop erly.The protruded space st enosis o ccurs relatively later and s