摘要
目的:探讨腰椎间盘突出症个性化治疗的必要性及实用性,分析个性化治疗的临床疗效。方法:503例腰椎间盘突出症患者,根据椎间盘突出物的大小,纤维环是否破裂,椎间盘是否游离、脱垂,是否合并椎管狭窄、腰椎滑脱及是否伴有神经症状等,分别采用个性化的保守治疗、微创治疗、开放性手术治疗。其中393例获得随访,男189例,女204例;年龄23～76岁,平均44.6岁。210例保守治疗,145例微创治疗,38例开放手术治疗。根据Macnab标准对治疗结果进行疗效评定。结果:393例患者平均随访16个月(3个月～3年)。根据Macnab标准:显效346例,有效29例,无效18例,显效率88%(346/393),有效率95%(375/393),无严重并发症。保守治疗复发率18.1%(38/210),微创治疗复发率9.6%(14/145),开放手术复发率5.3%(2/38)。结论:保守治疗应用普遍,对轻症患者疗效可靠;微创治疗应用越来越广,有主流趋势;开放手术治疗适应证要求严格,传统手术方式受到挑战。个性化治疗适应证的选择是提高疗效的重要途径。
To investigate the necessity, practicability for individualized treatment of lumbar intervertebral disc herniation and analyze its clinical effect. Methods ： Five hundred and three cases of lumbar intervertebral disc herniation from March 2005 to March 2008 were individually treated by conservative treatment, minimal surgical procedures, open operation according to the protrusible size, rupture status of annular fibrosus,liberation or prolapse of disk tissue, accompanying conditions like spinal stenosis, spondylolisthesis or nerve involvement. Three hundred and ninety-three cases （male 189, female 204） were followed with an average age of 44.6 years old （range from 23 to 76）. Among them, 210 cases were treated by conservative method, 145 cases by minimal surgical procedures and 38 cases by open operation. Therapeutic effect was evaluated by Macnab criteria. Results ：The mean follow-up duration was 16 months （range from 3 months to 3 years）. Therapeutic effect was noted as 346 of excellence, 29 of effective, 18 of ineffective. Excellence rate was 88% （346/393） and effective rate was 95% （375/393）. No severe complication was found. The recurrence rate of conservative treatment, minimal surgical procedures, open operation was respectively 18.1% （ 38/210）, 9.6% （ 14/145 ）, 5.3% （2/38 ）. Conchlsion ： Conservative treatment is generally applied, its effect is reliable for patients of mild symptom. Minimal surgical procedures is applied more and more wide, the method will become prevalent. The indications for open operation became stricter and traditional surgical methods was challenged by less invasive methods. Individualized treatment basing on indication judgment was the most importance to improve therapeutic effect.
出处
《中国骨伤》
CAS
2009年第4期274-276,共3页
China Journal of Orthopaedics and Traumatology
关键词
椎间盘移位
腰椎
个性化治疗
外科手术
微创性
保守治疗
Intervertebral disk displacement
Lumbar vertebrae
Individualized treatment
Surgical procedures,min-imally invasive
Conservative treatment
