早期干预对腰椎间盘突出症的影响——多中心大样本量随访  

Impact of early intervention on lumbar disc herniation:a large sample multicenter follow-up

作　　者：尹德龙[1] 程鹏[2] 范震波[1] 胡汉生[1] 黄晖[2] 郭风劲[2] 陈安民[2] 

机构地区：[1]广州医科大学附属第三医院骨科,广州市510150 [2]华中科技大学同济医学院附属同济医院骨科,武汉市430030

出　　处：《中国矫形外科杂志》2014年第13期1153-1157,共5页Orthopedic Journal of China

基　　金：国家科技支撑计划项目(编号:2007BAI04B07)

摘　　要：[目的]通过对腰椎间盘退变引起的腰椎间盘突出症病人的相关资料分析探讨腰椎问盘突出症的早期干预对腰椎间盘突出症愈后功能康复的影响。[方法]采用前瞻性和回顾性相结合的研究方法，以同济医院骨科及周边兄弟医院骨科收治的2007年6月～2010年10月术前确诊为腰椎问盘突出症的605例患者进行前瞻性研究并随访，2006年6月～2009年10月已诊断并行相应治疗的腰椎间盘突出症的710例患者病例进行分析并随访，按照RDQ功能障碍评分（Roland—morris指数）、腰痛JOA评分及VAS疼痛评分标准进行评定。[结果]所有病例，手术治疗占67％，保守治疗占33％，随访8—24个月（平均14．6个月）并按RDQ功能障碍评分、腰痛JOA评分及VAS疼痛评分标准进行近期效果评估。前瞻性研究的病例，RDQ评分患者由治疗前的（18．3±1．4）分改善为末次随访时的（8．1±1．5）分；腰痛JOA评分由治疗前的（8．5±1．3）分改善为末次随访时的（24．5±1．6）分。治疗前与末次随访时相比两个评分均有大幅改善，有统计学差异（P〈0．05）。VAS疼痛主观评分治疗前与末次随访时也有明显改善。回顾性研究的病例表明RDQ评分患者由治疗前的（16．3±1．5）分改善为末次随访时的（9．8±1．4）分；腰痛JOA评分由治疗前的（9．3±1．7）分改善为末次随访时的（20．2±1．4）分。治疗前与末次随访时相比两个评分均有改善，VAS疼痛主观评分治疗前与末次随访时也有明显改善。但早期干预患者（前瞻性研究）与未干预患者（回顾性研究）相比，有统计学差异（P〈0．05），表明在腰椎间盘突出症患者功能恢复方面有差异。[结论]早期干预对于腰椎间盘突出症患者来说，比未干预患者功能改善率高，治疗后功能恢复更好。[ Objective ] To investigate the impact of early intervention on lumbar disc herniation and to evaluate functional recovery following the intervention. [ Methods] In this study, we performed a prospective analysis in 605 patients preoperatively diagnosed with lumbar disc herniation between June 2007 and October 2010, and a retrospective analysis in 710 patients diag- nosed between June 2006 and October 2009. The patients were selected from the orthopedic department of our hospital and other hospitals. Both groups of patients underwent surgical intervention or formal conservative treatment. The Roland Morris Disability Questionnaire （RDQ）, Japanese Orthopaedic Association （JOA） low back pain scoring system, and visual analogue scale （VAS） were used to measure the clinical outcomes. [ Results] The surgical and nonsurgical patients accounted for 67% and 33% of all patients, respectively. All the patients were followed up for 8 -24 months. In the prospective analysis group, the mean RDQ score was 18. 3 before treatment and 8.1 at follow - up, the mean JOA low back pain scores were 8.5 and 24. 5, respectively. In the retrospective analysis group, the mean RDQ scores were 16. 3 and 9. 8, and the mean JOA low back pain scores were 9. 3 and 20. 2, before treatment and at follow - up, respectively. The scores for both indexes were obviously im- proved, the VAS score at follow - up was also improved after the treatment. However, early intervention showed a better effect in the prospective analysis than in the retrospective analysis. [ Conclusion ] Early intervention was effective for lumbar disc herniation.

关 键 词：腰椎间盘突出症 早期干预治疗 前瞻性研究 回顾性研究 

分 类 号：R681.53[医药卫生—骨科学]