单节段腰椎间盘突出症单纯髓核摘除术后10年以上随诊观察

Result of lumbar discectomy for single-level lumbar intervertebral disc herniation：a ten-year report

中文关键词:  腰椎间盘突出症  髓核摘除术  磁共振成像  远期  随访

英文关键词:Lumbar disc herniation  Discectomy  MRI  Long-term  Follow-up

中文摘要:

  【摘要】 目的：观察单纯髓核摘除术治疗单节段腰椎间盘突出症的远期疗效及影像学改变。方法：1990~1998年我院经单纯髓核摘除术治疗腰椎间盘突出症患者210例，对其中术后10年以上来门诊随访且资料完整的35例单节段腰椎间盘突出症患者进行回顾性分析，其中全椎板切除髓核摘除术10例，开窗减压髓核摘除术25例。随访内容包括：询问病史、骨科查体、摄腰椎正侧位及过伸过屈位X线片、行腰椎MRI检查及ODI评分，并对结果进行统计学分析。结果：随访时5例无腰腿疼痛症状，26例偶有腰痛及下肢酸痛，4例有明显腰腿痛。X线检查手术节段椎间隙变窄22例，占62.9%，手术节段残存活动度5.0°±3.2°，均未显示脊柱不稳定，依据U?鄄CLA标准8例（22.9%）手术节段头侧相邻节段存在退变。MRI检查6例患者原手术节段可见椎间盘突出（占17.1%），其中4例有明显腰腿痛症状；依据改良Pfirrmann椎间盘退变分级，头侧椎间盘1~5级27例，6级及以上8例；12例手术节段存在终板信号改变，占34.3%，其中Modic Ⅰ型4例，Ⅱ型8例。随访时手术节段椎间隙狭窄与无狭窄患者的ODI评分有显著性差异（P<0.05）。两种术式患者ODI、相邻节段退变发生率和手术节段活动度均无统计学差异（P>0.05）。结论：单节段腰椎间盘突出症单纯髓核摘除术后10年以上手术节段能保留一定活动度，无脊柱不稳发生，但手术椎间隙变窄、相邻节段退变发生率较高，其与腰部功能障碍相关。

英文摘要:

  【Abstract】 Objective：To investigate the long-term outcome and imaging findings of single-level discectomy for lumbar intervertebral disc herniation.Method：Two hundred and ten patients with single-level lumbar intervertebral disc herniation underwent discectomy from 1990 to 1998，of them，35 patients（10 laminectomy and discectomy，25 mini-laminotomy and discectomy） were followed up for more than 10 years.These 35 patients′ data including demographic record，physical examination，X-ray and MRI findings of lumbar spine as well as ODI assessment were reviewed retrospectively.Result：During follow-up，5 patients presented with no low back pain and sciatica；26 patients complained of transient low back pain and sciatica；while 4 suffered from severe irreducible lowback pain.Lumbar X-ray showed narrowing of intervertebral disc of surgical level in 22 cases（62.9%），and the remaining range of motion of surgical level was 5.0°±3.2°.Functional X-ray showed no instability of lumbar spine.According to UCLA criteria，cephalad adjacent segment degeneration（ASD） occurred in 8 cases（22.9%）.MRI showed recurrence of lumbar disc herniation in 6 patients（17.1%），but only four of them had symptoms and signs of recurrence.According to Pfirrmann intervertebral disc degeneration classification system，cephalad ASD ranked 1-5 in 27 cases，and 6 or more in 8 cases.12 cases including 4 Modic Ⅰ and 8 Modic Ⅱ showed varied signs of end plate degeneration（34.3%）.ODI assessment showed significant difference between disc narrowing and nonnarrowing groups.The ODI score，incidence of ASD and remaining ROM of surgical level between two surgical approaches showed no significant difference.Conclusion：Lumbar discectomy for single-level disc herniation can maintain ROM and spine instability of surgical level to some degree，however disc narrowing and adjacent segment degeneration are more prevalent，which may associate with low back malfunction.