腰椎间盘突出症非手术治疗的长期随防

A study of long term follow-up for treatment of intervertebral disc with non-surgical methods

目的:通过对我院资料完整,随访10年以上的经非手术治疗的腰椎间盘突出症患者进行回顾性研究,对治疗前后的临床表现和影像学资料进行客观评价,为临床上腰椎间盘突出症的治疗提供可靠的参考。方法:筛选10年以前在我院住院或门诊进行非手术治疗的诊断明确的腰椎间盘突出症患者,病历及影像学资料均完整,随访时能够合作的作为研究对象,本组患者的随访年限为10至38年,平均26年。观察指标为临床表现、影像学改变及相邻的上下椎间隙发生退变的情况,测量突出间隙治疗前与现在的椎间隙高度值并对其进行统计学分析。结果:经非手术治疗后至今,180例患者,161例自觉良好,可正常生活和工作,19例因出现明显间歇性跛行,分别于保守治疗后11年、17年和38年行椎管减压手术。本组椎间隙平均减低(3.17±1.65)mm。23例出现相邻椎间隙轻度退变。结论:如适应证选择得当,经非手术治疗的腰椎间盘突出症患者其长期随访结果良好;非手术治疗组的突出间隙出现狭窄的时间较晚、程度较轻,很少发生相邻间隙的退变;非手术治疗可为椎间盘突出症的首选疗法。

Objective;In order to provide a valid and firsthand long-term follow-up results of lumbar intervertebral disc herniation treatment, and to help the therapy of this disease, this retrospective study was made through an objective evaluation of the results of non-surgical therapies for cases treated ten years ago in our hospital. Methods; The definite lumbar intervertebral disc herniation cases, which were treated in our in-patient and out-patient department ten years ago, and strictly followed up in our hospital in recent ten years, were carefully selected for this study. The medical records and imageological materials of the patients were all intact. And they were all very cooperative. The follow-up duration (time) for the patients was 10 to 38 years. The long term therapeutic effects and the imageological change were observed. The height difference of intervertebral space in the protruded space was measured before treatment and the latest follow-up. And degeneration of the two intervertebral spaces adjacent to the protruded intervertebral space was also observed. Results; Among the 180 cases in non-surgical group, the effect was quite good in 161 cases and the patients undertook almost a normal life and work, vertebral canal decompression was performed 11 - 38 years later respectively for the rest 19 cases because of intermittent claudication. The protruded intervertebral space was decreased 3. 17 ±1.65mm averagely in height after non-surgical treatment. The adjacent intervertebral space degeneration was observed in 23 cases. Conclusions: The effect of lumbar intervertebral disc herniation treated by non-surgical therapy was good after a long-term follow-up observation. For non- surgical group, the protruded space stenosis occurred relatively late and was slight in severity, and the adjacent interteverbrai space degeneration occurred relatively less. We suggest non- surgical therapy should be as the first selectivity.