非手术治疗破裂型腰椎间盘突出症5年随访研究  

A 5-year follow-up study on non-surgical treatment of ruptured lumbar disc herniation

作　　者：戴锋 俞鹏飞 刘锦涛 姜宏 DAI Feng;YU Peng-fei;LIU Jin-tao;JIANG Hong(The Affiliated Hospital of Nanjing University of Chinese Medicine,Suzhou Hospital of Traditional Chinese Medicine,Suzhou 215009,Jiangsu,China)

机构地区：[1]南京中医药大学苏州附属医院苏州市中医医院,江苏苏州215009

出　　处：《中国骨伤》2020年第5期414-419,共6页China Journal of Orthopaedics and Traumatology

基　　金：苏州市科技局资助(编号:sysd2017131)。

摘　　要：目的:探讨非手术治疗破裂型腰椎间盘突出症的近中期疗效及预后转归。方法:选取2011年2月至2014年2月接受非手术治疗的75例单节段破裂型腰椎间盘突出症患者进行前瞻性研究,男53例,女22例;年龄18~58(35.62±9.96岁);病程5 d^6个月,平均(46.45±40.66)d。突出节段:L3,44例,L4,529例,L5S142例。放射痛左侧46例,右侧29例。选取治疗前,治疗后3个月、6个月、1年、2年、5年6个时间点对患者JOA评分、直腿抬高角度(SLRT)、指地距统计分析。计算末次随访时(治疗后5年)JOA改善率,根据JOA评分评定疗效;分析治疗前、末次随访(治疗后5年)椎间盘突出物体积变化,计算突出物体积吸收率,观察突出物吸收情况;分析JOA改善率与突出物吸收率之间关系。结果:71例患者完成随访,非手术治疗后3个月、6个月、1年、2年、5年JOA评分、SLRT、指地距与治疗前比较,差异有统计学意义(P<0.05)。治疗后5年与6个月、治疗后5年与2年、治疗后2年与6个月JOA评分比较,差异无统计学意义(P>0.05),其余各时间点两两比较,差异均有统计学意义(P<0.05);治疗后5年与6个月、治疗后5年与2年、治疗后2年与6个月SLRT、指地距比较,差异亦无统计学意义(P>0.05),其余各时间点两两比较,差异均有统计学意义(P<0.05)。末次随访JOA改善率为(62.69±2.47)%,按照JOA评分评定疗效,结果优26例,良26例,可14例,差5例,优良率73.24%;突出物体积由起始的(1981.73±588.72)mm3减少至(1011.82±395.47)mm3,总体吸收率(45.65±2.83)%,突出物发生明显吸收24例,部分吸收26例,未吸收19例,增大2例。JOA改善率与突出物吸收率作Spearman秩相关分析,发现两者呈中等以上正相关(r=0.679,P<0.001)。结论:非手术治疗破裂型腰椎间盘突出症可取得良好疗效,明确了破裂型腰椎间盘突出症的病情特点及预后转归,同时部分患者发生"重吸收"现象。Objective:To investigate the short-term and mid-term efficacy with non-surgical treatment and to predict the long-term outcomes of ruptured lumbar disc herniation.Methods:From February 2011 to February 2014,75 patients with single-segment ruptured lumbar disc herniation treated by non-surgical therapy were selected for prospective study.There were 53 males and 22 females,aged from 18 to 58(35.62±9.96) years old.The course of disease was from 5 days to 6 months,with an average of(46.45±40.66) days.The lesions were located at L3,4 in 4 cases,at L4,5 in 29 cases,at L5 S1 in 42 cases.Radiation pain in 46 cases on the left and 29 cases on the right.The JOA score,straight leg raising test angle and finger-to-ground distance were assessed pretreatment and at 3 months,6 months,1 year,2 years and 5 years after treatment.The improvement rate of JOA at the final follow-up(5 years after treatment) was calculated and the curative effect according to JOA score was evaluated;the volume change of protrusion before treatment and at the final follow-up(5 years after treatment) was analyzed,the volume absorption rate of protrusion was calculated and the absorption of protrusion was observed;the relationship between the improvement rate of JOA and the absorption rate of protrusion were analyzed.Results:Seventy-one patients were finally followed up at 5 years after non-surgical treatment.The JOA score,straight leg raising test angle and finger-to-ground distance at 3 months,6 months,1 year,2 years and 5 years after treatment were significantly improved(P<0.05).There was no significant difference in JOA scores between 5 years and 6 months after treatment,5 and 2 years after treatment,and 2 years and 6 months after treatment(P>0.05).There was significant difference in other time points(P<0.05).The results of the straight leg raising test angle and the finger-to-ground distance were similar to the JOA scores.The improvement rate of JOA score was(62.69±2.47)% at the final follow-up.According to JOA score,the results were excellent in

关 键 词：腰椎间盘突出症 破裂型 非手术 重吸收 

分 类 号：R681[医药卫生—骨科学]