椎板开窗髓核摘除纤维环缝合术与单纯髓核摘除术对青少年腰椎间盘突出症的早期疗效  

Comparison of results between fenestration discectomy associated with annulus repair and fenestration discectomy for lumbar disc herniation in the adolescents

作　　者：李杰[1] 马超[1] 李益明[1] 王兆红[1] 赵猛[1] 冯杰[1] 戴维享[1] 

机构地区：[1]江苏省徐州市中心医院脊柱外科,221009

出　　处：《中华医学杂志》2016年第32期2573-2577,共5页National Medical Journal of China

基　　金：吴阶平医学基金会临床科研专项（320-2745-16-037）

摘　　要：目的比较椎板开窗髓核摘除纤维环缝合术（FDAR）与单纯椎板开窗髓核摘除术（FD）对青少年腰椎间盘突出症（LDH）的早期疗效。方法对2012年10月至2014年10月徐州市中心医院脊柱外科确诊为单节段单侧LDH的26例青少年患者的临床资料进行回顾性分析。其中FDAR组12例，FD组14例。比较两种术式的切口长度、手术出血量、手术时间、术后住院时间。观察并测量术前、术后12个月腰椎MRI上责任椎间盘硬膜外压迹大小，按Pfirrmann分级评价其退变程度；记录并比较两组患者术前及术后3、12个月的视觉疼痛模拟评分（VAS）、Oswestry功能障碍指数（ODI）评分。术后12个月随访时采用日本矫形外科协会（JOA）评分及改良MacNab评价标准进行评价。并观察两组手术并发症及术后复发情况。结果FDAR组男7例，女5例，年龄16—20岁，平均（17．9±1．3）岁；FD组男9例，女5例，年龄16—21岁，平均（18．2±1．8）岁，两组患者均顺利完成手术及随访。两组的手术切口长度、手术出血量、手术时间和术后住院时间比较差异均无统计学意义（均P〉0．05）。两组患者术前、术后椎间盘退变程度按Pfirrmann分级评价结果接近，术前FDAR组Ⅲ级8例Ⅳ级4例，FD组Ⅲ级9例Ⅳ级5例；术后FDAR组Ⅲ级10例Ⅳ级2例，FD组Ⅲ级10例Ⅳ级4例。FDAR组和FD组术后12个月硬膜外压迹大小分别为（7．3±2．6）和（7．4±3．1）mm，均显著小于术前的（1．3±0．8）和（2．9±0．7）mm（均P〈0．05）。术后3、12个月VAS、ODI评分均较术前显著改善（均P〈0．05）。FDAR组与FD组术后12个月JOA评分改善率及改良MacNab评价疗效优良率均相近（88．5％比87．2％及89．3％比88．5％，均P〉0．05）。患者均未发生严重并发症，其中FD组有1例复发，对症保守治疗后症状缓解，未再次行手术治疗。结论FDAR和FD均能有效治疗青少年LDH，早�Objective To compare the preliminary clinical outcomes of fenestration discectomy associated with annulus repair （FDAR） and fenestration diseectomy （FD） for lumbar disc herniation in the adolescents. Methods The data of 26 adolescent patients with single segment lumbar disc herniation who were admitted to the Department of Orthopedics, Xuzhou Central Hospital from October 2012 to October 2014 were retrospectively studied. All patients were divided into 2 groups, including 12 patients undergoing FDAR and 14 patients undergoing FD respectively. The factors including the length of skin incision, amount of intraoperative bleeding, operation time and duration of hospitalization were compared. The indentation of dura were measured from MRI. Pfirrmann grading system was used for assessment of lumbar disc degeneration preoperatively and 1 year later. The visual analogue scale （VAS） , the oswestry disability index （ODD and Japanese Orthopedic Association （JOA） scores were used to measure the clinical outcomes.Simultaneously, surgical complications, and postoperative recurrence of lumbar disc herniation were recorded. Results There were no significant differences in the observational factors such as the skin incision length, amount of intraoperative bleeding, operation time, and duration of hospitalization between the FDAR and FD groups （P 〉 0. 05）. The indentation of the dura significantly reduced after surgery in each group [FDAR： （7.3±2.6） vs （1.3±0.8） mm; FD： （7.4±3.1） vs （2.9±0.7） mm; bothP〈0.051. The postoperative lumbar disc degeneration in FDAR group was the same as that of in FD group. The postoperative VAS scores and ODI scores at each follow-up time point in both groups were significantly improved when compared with the preoperative ones （ P 〈 0. 05 ）. There were no statistically significant differences between the 2 groups in the JOA score improvement rate （ FDAR： 88.5%, FD： 87.2% ; P 〉0. 05 ）. According to the modified MacNab criteria, there wer

关 键 词：椎间盘移位 腰椎 椎间盘切除术 青少年 

分 类 号：R687.3[医药卫生—骨科学]