经皮激光椎间盘减压术治疗腰椎间盘突出症的中期疗效观察

中文关键词:  经皮激光椎间盘减压术  腰椎间盘突出症  激光  中期疗效

英文关键词:Percutaneous laser disc decompression  Lumbar disc herniation  Laser  Mid-term efficacy

中文摘要:

  【摘要】 目的：观察经皮激光椎间盘减压术（PLDD）治疗腰椎间盘突出症（LDH）的中期疗效。方法：2003年1月～2007年5月，应用PLDD治疗且获得3年及3年以上随访的腰椎间盘突出症患者87例，其中男45例，女42例，年龄22～80岁，平均52岁。激光汽化总能量500～800J/椎间盘，平均644.8J/椎间盘。术前及术后不同时期应用JOA法评定疗效，同时应用NRS法对患者术前及末次随访时各主要症状（腰痛、下肢疼痛、下肢麻木）进行评分。另外，将患者按年龄分为≤55岁组和＞55岁组，比较两组的疗效。观察是否出现并发症。结果：随访87例患者，随访时间为36.0～88.5个月，平均60.1个月，按JOA疗效评定方法，术后1个月、3个月、6个月、≥1年、≥2年、≥3年、≥4年、≥5年、≥6年的JOA优良率分别为55.17%、77.01%、81.61%、81.61%、85.06%、87.35%、85.71%、85.10%、84.21%，术后不同时期优良率与术后1个月比较，P＜0.05，差异有统计学意义；末次随访时各主要症状NRS评分与术前比较，P＜0.01，差异有统计学意义。术后3年以上，年龄≤55岁和＞55岁组优良率比较，P>0.05，差异无统计学意义。所有患者均未见并发症发生。结论：PLDD治疗腰椎间盘突出症的中期疗效良好，术后3~6年以上疗效稳定，是治疗腰椎间盘突出症较好的微创方法。

英文摘要:

  【Abstract】 Objectives: To investigate the mid-term outcome of percutaneous laser disc decompression(PLDD) for lumbar disc herniation(LDH). Methods: Patients with LDH had accepted PLDD from January 2003 to May 2007, 87 cases after treatment were followed up. Of these, there were 45 males and 42 females, aged from 22 to 80 years(mean 52 years). Total energy was 500-800J/disc, the average was 644.8J/disc. The Japanese Orthopaedics Association(JOA) standard was used to evaluate the therapeutic efficacy. The Numeric Rating Scales(NRS) was used to score the main symptoms(back pain, leg pain, numbness) at preoperation and final follow-up after operation. All the patients were divided into age≤55 years group and ＞55 years group, comparing the efficacy of the both groups. At the same time, complications were reviewed. Results: 87 patients were followed up for an average of 60.1 months(36.0 to 88.5 months), the excellent-to-good rate of JOA score at 1 month, 3 months, 6 months, ≥1 year, ≥2 years, ≥3 years, ≥4 years, ≥5 years, ≥6 years post-operation was 55.17%, 77.01%, 81.61%, 81.61%, 85.06%, 87.35%, 85.71%, 85.10%, 84.21% respectively, which showed significant difference compared with 1 month after operation(P<0.05). The NRS score for main complaints at final follow-up showed significant difference compared with preoperative ones. After 3-year follow-up, patients with age less than 50 years and over 50 years showed no significant difference(P>0.05). No complication was noted in all patients. Conclusions: Mid-term outcome of PLDD for LDH is good and stable, which remains the ideal method for lumbar disc herniation.