广泛膨出型腰椎间盘突出症的内固定治疗:与单纯开窗治疗比较

摘要

背景 对于广泛膨出型腰椎间盘突出症的治疗采用内固定还是单纯手术仍存在争议.目的 比较内固定与单纯开窗治疗广泛膨出型腰椎间盘突出症的疗效.方法 回顾性分析2004-12/2009-12 珠江医院收治的有根性症状的152 例广泛膨出型腰椎间盘突出症患者,55 例行单纯开窗减压髓核摘除治疗(单纯组),97 例行髓核纤维环摘除,椎间撑开植骨融合,椎弓根钉内固定(融合组).治疗后定期进行随访.结果与结论 影像学检查显示,治疗后6 个月和6 年时,单纯组椎间隙相对高度明显下降,而融合组椎间隙高度比术前增高(P < 0.05).治疗前及治疗后6 个月,两组患者疼痛目测类比评分和Oswestry 功能障碍评分差异无显著性意义(P > 0.05),治疗后6 年,融合组的疼痛目测类比评分和Oswestry 功能障碍评分均优于单纯组(P < 0.01).提示,对于广泛膨出型腰椎间盘突出症,行髓核及突出纤维环摘除,椎间撑开植骨融合,椎弓根钉内固定的远期疗效优于单纯髓核摘除.%BACKGROUND: There has been a controversy concerning whether fusion or not is applied in the treatment of lumbar disc herniation.OBJECTIVE: To compare the curative effects of instrumented fusion and simple fenestration discectomy in the treatment of bulged lumbar disc herniation.METHODS: Totally 152 patients with bulged lumbar disc herniation treated between December 2004 and December 2009 in Zhujiang Hospital were reviewed. Fifty-five cases underwent simple fenestration discectomy (simple fenestration group), 97cases received nucleus pulposus annulus extraction, instrumented intervertebral fusion and pedicle screw fixation (fusion group).Follow-up was performed termly after operation.RESULTS AND CONCLUSION: X-rays showed that the intervertebral height of simple fenestration group was significantly reduced at 6 months and 6 years after operation whereas the intervertebral height of the fusion group was increased at these two time points (P < 0.05). There was no significant difference in visual analogue score and Oswestry score before and 6 months after operation between two groups (P > 0.05). However, 6 years later, the mean visual analogue score and Oswestry score in the fusion group were significantly lower than that in the simple fenestration group (P < 0.01). For bulged disc herniation, nucleus pulposus annulus extraction, instrumented intervertebral fusion and pedicle screw fixation have better long term results compared with simple fenestration discectomy.