轻症颈椎间盘突出症的保守治疗效果及手术时机选择  

Outcomes of conservative treatment and timing of surgical intervention for mild cervical disk herniation

作　　者：陈怀志[1] 胡成栋[1] 霍喜卫[1] 任冬云 

机构地区：[1]河北省邯郸市中心医院,河北邯郸056001 [2]河北省邯郸县妇幼保健院,河北邯郸056001

出　　处：《现代中西医结合杂志》2014年第25期2742-2744,共3页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：河北省科技计划项目(12277750)

摘　　要：目的探讨轻症颈椎间盘突出症患者的保守治疗效果、手术时机的选择及影响患者病情进展的相关因素。方法 90例轻症颈椎间盘突出症患者首先进行正规保守治疗,并定期随访,当保守治疗无效或病情进展时,及时给予手术治疗,以JOA评分作为疗效评价的标准。同时,对影响病情进展的相关因素进行分析。结果对患者进行2 a以上的随访。78例获得完整随访且数据完整,其中有21例因神经症状加重进行了手术治疗(A组),其余57例始终行保守治疗(B组)。B组患者经保守治疗后神经功能获得明显恢复。A组患者经手术治疗后JOA评分有明显恢复(P<0.05),但末次随访时与B组比较差异无统计学意义(P>0.05)。组间比较显示,颈椎管狭窄、节段不稳是导致轻症颈椎间盘突出症患者神经症状加重的危险因素。结论对于轻症颈椎间盘突出症患者,正规保守治疗往往有效;当伴有颈椎管狭窄、节段不稳等危险因素时,保守治疗效果差,需给予手术治疗。Objective It is to investigate the outcomes of conservative treatment and timing of surgical intervention and cor -related factors which influence the disease development in patients with mild cervical disk herniation （ MCDH ） .Methods Ninety MCDH patients initially received conservative treatment and were followed up periodically .When a deterioration of my-elopathy was clearly identified , surgical intervention was carried out .Clinical and radiological factors related to the deteriora-tion were examined , and final clinical outcomes were evaluated by the Japanese Orthopedic Association （ JOA） score.Results More than 2-year following-up was finished .78 patients with whole following up process and data were available for the a-nalysis.Only 21 patients deteriorated and underwent surgery thereafter （group A）, while the other 57 patients were treated conservatively throughout （group B）.Statistical analysis revealed that segmental instability and cervical spinal stenosis were adverse factors for poor prognosis of conservative treatment .Both group A and B had a significant increase in JOA scores （ P〈0.05）, however, there was no significant difference in JOA scores between the two groups at final follow -up （P〉0 .05）. Conclusion Normal and conservative treatment works well in MCDH patients .Patients with segmental instability and cervical spinal stenosis are prone to deteriorate , and surgical intervention tend to apply to those patients .

关 键 词：颈椎间盘突出症 保守治疗 手术治疗 预后 

分 类 号：R068.155[医药卫生]