飞行员腰椎退行性疾病手术治疗方式的选择及术后飞行鉴定的评价分析  

Selection of individualized surgery for pilot lumbar degenerative diseases and analysis of flight qualification after operation

作　　者：吕奥 黄小刚 王洁[2] 杜俊杰[1] 伍骥[1] 郑超[1] 尚咏[1] 

机构地区：[1]空军总医院骨科,北京100142 [2]空军总医院神经内科,北京100142

出　　处：《空军医学杂志》2017年第5期289-292,共4页Medical Journal of Air Force

摘　　要：目的分析飞行员腰椎退行性疾病采用不同手术的临床疗效,根据随访结果,初步探讨分析不同手术治疗腰椎退行性疾病后的飞行鉴定标准。方法回顾性分析空军总医院2010年3月—2016年3月收治的腰椎退行性疾病的现役空军飞行员14例,根据腰椎退行性疾病的类型选择个体化手术治疗方式。分别收集评估患者手术前及术后12个月的Oswerstry功能障碍指数(ODI)、腰椎JOA评分、下腰痛视觉模拟评分法(VAS)和飞行鉴定结果。结果 14例飞行员均获随访,随访时间12~36个月,平均27个月;地面观察时间4~12个月,平均8个月。9例退行性腰椎间盘突出症飞行员中,微创手术组与传统开放手术对比,术后12个月的ODI指数、腰椎JOA评分、下腰痛VAS评分差异无统计学意义,而2组术前与术后12个月比较差异有统计学意义,8例术后经6个月康复训练后飞行鉴定合格,1例飞行鉴定不合格;5例退行性腰椎管狭窄症合并腰椎滑脱飞行员中,术后经12个月康复训练后飞行鉴定合格。13例飞行员术后飞行状态良好,平均术后飞行时间为431 h,随访无新发下腰痛等不适症状,腰椎X线片、CT检查未发现继发腰椎不稳征象。结论对于保守治疗无效的腰椎退行性疾病飞行员,采用个体化的手术治疗方法,疗效满意,术后经恰当的康复训练后,均可在12个月内鉴定飞行合格。为了最大限度保存空军飞行人员战斗力,现有的鉴定标准需要结合临床实践、飞行需求等因素不断补充完善。Objective To analyze the clinical effect of different surgical approaches to lumbar degenerative disease among pilots and to explore flight qualification standards after different operations according to the follow-up results. Methods A retrospective analysis was conducted among fourteen cases of Air Force active pilots admitted to Air Force General Hospital between March 2010 and March 2016. The approach to surgery was determined according to the type of degenerative lumbar spinal disorders. Oswerstry disability index （ODI） and lumbar JOA score, low back pain visual analog score （VAS） before surgery and 12 months after surgery and the identification results were collected. Results These fourteen pilots were followed-up for 12-36 months, an average of 27 months. Ground observation time was 4-12 months, an average of 8 months. ODI index, lumbar JOA score and low back pain VAS score of nine pilots with degenerative lumbar disc herniation 12 months after surgery were not significantly different between minimally invasive surgery and open surgery, but the change of these indexes was statistically significant after surgery. Eight cases were determined to be qualified for flying after 6 months of rehabilitation, but one case was unqualified. Five cases of degenerative lumbar spinal stenosis complicated with lumbar spondylolisthesis were permitted to fly after 12 months of rehabilitation training. Thirteen of these pilots remained in good health after operation, whose average flight time was 431 h. According to the follow-up result, there was not any new symptom, such as lower back pain, and both lumbar spine radiographs and CT examinations found no signs of secondary lumbarspine instability. Conclusion For pilots with lumbar degenerative disease on whom conservative treatment had poor therapeutic effect, individualized surgery can have satisfactory effects and help months after appropriate rehabilitation training. The identification standards in qualify force sh practice, flight requirements and other factors t

关 键 词：飞行员 腰椎退行性疾病 飞行鉴定 

分 类 号：R856.6[医药卫生—航空、航天与航海医学]