摘要
[目的]观察脱出游离型腰椎间盘突出症单纯摘除脱出髓核,不切开后纵韧带、纤维环及不摘除椎间隙内残留髓核组织手术方式的疗效。[方法]分析本院自2010年以来获得完整随访的脱出游离型腰椎间盘突出症术后患者94例。其中47例为保留组,即术中不另外切开纤维环、后纵韧带,不探查椎间隙,仅单纯摘除脱出游离的髓核。另外47例为常规组,即采用传统手术方式,术中摘除髓核后,常规切开纤维环及后纵韧带,摘除椎间隙内变性髓核组织。对比两组患者手术时间、术中出血量、住院时间、疼痛视觉模拟量表(VAS),Oswestry功能障碍指数(ODI)和椎间隙高度,依据改良Mac Nab疗效评定标准对手术疗效进行评价。[结果]保留组在手术时间及术中出血量上均明显少于常规组,差异有统计学意义(P<0.05)。两组患者随术后时间延长,VAS,ODI均显著下降,不同时间点间的差异均有统计学意义(P<0.05);但任何相同时间点,两组间在VAS和ODI的差异均无统计学意义(P>0.05)。末次随访时,两组间Mac Nab优良率及复发率的差异无统计学意义(P>0.05),但是,保留组后手术节段椎间盘高度丢失显著少于常规组,差异有统计学意义(P<0.05)。[结论]对脱出游离型椎间盘突出症患者实行手术时不需要另外扩大纤维环破口探查椎间隙,能减少手术时间及术中出血量,术后有利于维持椎体间高度,减缓手术节段椎间盘退变。
[Objective] To observe the clinical outcomes of removal of free lumbar disc alone without interference of the posterior longitudinal ligament（PLL） and annulus fibrosus（AF）.[Methods] A retrospective study was conducted on 94 patients who underwent surgical treatment for prolapsed or sequestered lumbar disc herniation in our hospital since 2010.Of them,47 patients had the free lumbar disc removed only without interference of PLL and AF（the preservation group）,while the remaining47 patients received conventional removal of the free disc and disc at intervertebral space through incision of PLL and AF（the conventional group）.The operative time,intraoperative blood loss,hospital stay,visual analog scale（VAS） of pain,Oswestry disability index（ODI）,and intervertebral height（IVH） measured radiographically were compared between the two groups,and the consequences were assessed using the modified Mac Nab criteria.[Results] The preservation group consumed significantly shorter operation time,associated with significantly less intraoperative blood loss than the conventional group（P〈0.05）.The VAS and ODI in both groups significantly decreased over time after operation,with statistical differences among time points（P〈0.05）,despite the fact that no statistical differences were noted in any corresponding time point between the two groups（P〉0.05）.At the latest follow up,no statistical differences regarding to the excellent and good rate of clinical outcome and recurrence rate were found between them（P〉0.05）,although the preservation group had significantly less IVH loss than the conventional group（P〈0.05）.[Conclusion] For the prolapsed or sequestered intervertebral disc herniation,only the intraspinal free disc should be removed while the PLL and AF are unaffected,which take advantages of shortening operation time,reducing intraoperative blood loss,maintaining IVH and retarding degenerative process of involved segment.
作者
吕超
吴小松
叶正云
LV Chao;WU Xiao-song;YE Zheng-yun(Department of Spine Surgery,The Jingmen No.1 People＇s Hospital,Jingmen 448000,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2018年第17期1570-1573,共4页
Orthopedic Journal of China
关键词
脱出型
游离型
腰椎间盘突出症
后纵韧带
纤维环
prolapse type
sequestered type
lurebar disc herniation
posterior longitudinal ligament
annulus fibrosus
