背景:腰椎间盘突出症越来越年轻化,青年患者该采用何种术式是每个骨科医生必须要面临的问题.目的:观察Bioflex弹性内固定治疗青年单节段腰椎间盘突出症的疗效及影像学特征.方法:将2013年10月至2015年11月在深圳市中医院住院并确诊的80例青年单节段腰椎间盘突出症患者随机分为试验组和对照组,每组40例.试验组采用Bioflex 动态稳定系统腰椎弹性内固定治疗,对照组采用经皮椎间孔镜髓核摘除术治疗.分别使用腰腿痛目测类比评分、日本骨科协会下腰痛评分、Oswestry功能障碍指数进行临床疗效评价.于术前、术后及术后3,6,12 个月随访时行腰椎正侧位DR片及CT、MRI检查,测量病变经手术节段椎间盘腹侧高度、椎间盘背侧高度、棘突间顶距、椎间孔最大距离.比较两种术式的手术时间、术中出血量及并发症.结果与结论:①术后12个月,试验组在维持手术节段椎间盘腹侧高度、椎间盘背侧高度、棘突间顶距、椎间孔间最大高度上均优于对照组(P < 0.05);②与术前相比,术后2 组JOA下腰痛评分明显升高,腰腿痛目测类比评分及ODI明显降低(P < 0.05);术后3,6个月,2组各项评分差异无显著性意义(P > 0.05);术后12个月,2组各项评分差异有显著性意义(P < 0.05),试验组优于对照组;③两种手术方法的手术时间、术中出血量差异均有显著性意义,对照组更优(P < 0.05);④并发症上2组差异无显著性意义(P > 0.05);⑤结果显示,虽然在手术时间及术中出血量上经皮椎间孔镜占有优势,但是两种术式的早期疗效及并发症并无差异,而且就远期疗效来讲,Bioflex 弹性内固定手术在缓解患者症状、维持椎间高度、防止椎间盘及相邻椎体进一步退变等效果上明显优于经皮椎间孔镜髓核摘除.%BACKGROUND: The age of patients with lumbar disc herniation tends to younger, and choosing which surgical method for young patients is a difficult in clinic. . OBJECTIVE: To investigate the curative efficacy and imaging characteristics of the dynamic stabilization using Bioflex System for young patients with single-level lumbar disc herniation. METHODS: Eighty patients diagnosed for single level lumbar disc herniation in Shenzhen Hospital of Chinese Medicine from October 2013 to November 2015 were randomly divided into experimental and control groups (n=40 per group). The patients in the experimental group underwent dynamic stabilization using Bioflex System, and the controls received percutaneous transthoracic discectomy. The Visual Analogue Scale and Japanese Orthopedic Association scores and Oswestry Disability Index were used to evaluate the clinical efficacy. The ventral and dorsal intervertebral disc height, distance between spinous processes, and the maximum height between intervertebral foramens were measured through digital radiography, CT and MRI examinations at baseline, 3, 6, and 12 months of follow-up. The operation time, intraoperative blood loss and complications were compared between groups. RESULTS AND CONCLUSION: (1) At 12 months postoperatively, the restoration of the ventral and dorsal intervertebral disc height, distance between spinous processes, and the maximum height between intervertebral foramens in the experimental group were significantly superior to those in the control group (P < 0.05). (2) The Visual Analogue Scale and Japanese Orthopedic Association scores and Oswestry Disability Index scores were significantly improved in both groups (P < 0.05); all above scores did not differ significantly between two groups at 3 and 6 months postoperatively (P >0.05); and all above scores in the experimental group were significantly superior to those in the control group at 12 months postoperatively (P < 0.05). (3) The operation time and intraoperative blood loss in the experimental group were significantly lower than those in the control group (P < 0.05). (4) There were no significant differences in the incidence of complications between two groups (P > 0.05). (5) These results show that although percutaneous transthoracic discectomy has advantages on the operation time and intraoperative blood loss; the two surgical methods show no significant differences in the early curative efficacy and complications. Besides, in terms of long-term efficacy, Bioflex System can significantly alleviate pain, restore intervertebral height, and prevent degeneration of the intervertebral disc and adjacent vertebrae.
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