三种手术方法治疗腰椎椎间盘突出症的影像学及临床疗效比较  

Radiological and clinical outcomes of three different kinds operation in treatment of lumbar disc herniation

作　　者：田海军[1] 杨立利[1] 何志敏 陈宇[1] 杨海松[1] 黄平[1] 张伟[1] 缪锦浩[1] 陈德玉[1] 

机构地区：[1]第二军医大学附属长征医院骨科,上海200003 [2]上海市奉贤区中心医院骨科

出　　处：《脊柱外科杂志》2010年第6期339-344,共6页Journal of Spinal Surgery

摘　　要：目的比较单纯髓核摘除术（lumber discectomy,LD）、腰椎后外侧融合术（posterolateral lumbar fusion,PLF）和腰椎后路椎体间融合术（posterior lumbar interbody fusion,PLIF）治疗腰椎椎间盘突出较大或椎间盘突出伴有节段不稳的差异,进一步明确PLIF治疗腰椎间盘突出症的指征。方法回顾性分析2006年5月~2008年12月行手术治疗的腰椎椎间盘突出较大或椎间盘突出伴有节段不稳的患者102例。按手术方式分为3组,LD组37例,PLF组31例,PLIF组34例。比较各组手术前、后及随访时的椎间高度、椎间孔面积、腰椎生理曲度等影像学指标以及视觉模拟量表（visual analog scale,VAS）评分、Oswestry功能障碍评分等临床症状指标。同时,比较2个融合手术组的融合率。结果 PLIF组椎间高度及节段角度的恢复与维持明显优于其他组,差异有统计学意义（P〈0.05）,各组椎间孔面积手术前后均无明显变化;PLIF组融合率高于PLF组,但差异无统计学意义（P〉0.05）;PLIF组术后腰痛VAS评分低于其他组,差异有统计学意义（P〈0.05）,下肢疼痛VAS评分和Oswestry功能障碍评分差异无统计学意义（P〉0.05）,但随访发现PLIF组Oswestry功能障碍评分有逐渐优于其他组的趋势。结论与其他2种手术方式相比,PLIF治疗腰椎椎间盘突出较大或椎间盘突出伴有节段不稳时能更好的恢复腰椎的生理曲度,维持腰椎的稳定性,并能明显改善患者的腰痛症状。Objective To compare the difference between lumber discectomy（LD）,posterolateral lumbar fusion（PLF） and posterior lumbar interbody fusion（PLIF） in the treatment of lumbar massive disc herniation or disc herniation with segmental instability,and to identify the indication for PLIF.Methods A total of 102 patients with lumbar massive disc herniation or disc herniation with segmental instability who underwent surgical procedures from May 2006 to December 2008 were analyzed retrospectively.They were separated into 3 groups according to the surgical technique that was used： LD group with 37 cases,PLF group with 31 cases,PLIF group with 34 cases.Disc height,intervertebral foramen area and lumbar lordosis were measured pre-and postoperatively and during the follow-up.The visual analog scale（VAS） and Oswestry disability score were measured to evaluate low back pain,leg pain and disability.Fusion rates were also calculated in 2 fusion groups.Results The PLIF group had better results both in the disc height and the segment angle than the other 2 groups,and the differences were statistically significant（P0.05）,but the differences of foramen area between pre-and post-operation was not significant in each group（P0.05）.PLIF group showed a higher fusion rate than PLF,but the difference was not statistically significant（P0.05）.PLIF group also experienced a better relief of low back pain measured by VAS than the other 2 groups,and the differences were statistically significant（P0.05）,however the differences in leg pain VAS and Oswestry disability score were not significant（P0.05）.Conclusion Instrumented PLIF is an effective treatment for lumbar disc herniation with massive extrusion and/or segmental instability,which can get better curvature,stability and relief of low back pain than PLF and LD.

关 键 词：腰椎 椎间盘移位 关节不稳定性 椎间盘切除术 脊柱融合术 内固定器 

分 类 号：R681.533.1[医药卫生—骨科学]