【摘要】：背景:研究表明,腰椎間盤突出髓核摘除后行纖維環(huán)縫合可在獲得良好療效的同時降低復(fù)發(fā)率,但有效的修復(fù)方法及可靠的修復(fù)器械報道極少。目的:觀察在可擴張脊柱微創(chuàng)通道下腰椎間盤突出癥髓核摘除后進行纖維環(huán)裂口縫合修復(fù)的臨床效果。方法:納入2013年8月至2015年8月湖北省中醫(yī)院收治的腰椎間盤突出癥患者50例,隨機分為2組,縫合組25例在髓核摘除后行纖維環(huán)縫合術(shù),對照組25例單純行髓核摘除術(shù)。記錄并比較2組切口長度、手術(shù)時間、術(shù)中失血量,評估治療前后Oswestry功能障礙評分(ODI)、腰痛及下肢痛的目測類比評分,同時觀察手術(shù)并發(fā)癥及復(fù)發(fā)情況。結(jié)果與結(jié)論:(1)縫合組25例患者獲得完整隨訪,對照組只有23例完成隨訪;(2)2組患者性別、年齡及手術(shù)節(jié)段等相比差異無顯著性意義(P0.05);(3)2組目測類比評分及ODI術(shù)后各時間點與術(shù)前比較均明顯降低(P0.05)。2組間比較,除術(shù)后1個月的目測類比評分外,縫合組與對照組術(shù)前及術(shù)后ODI、目測類比評分比較差異均無顯著性意義(P0.05);(4)對照組2例復(fù)發(fā),其中1例行再手術(shù)治療,復(fù)發(fā)率9%;縫合組中1例復(fù)發(fā),并未再次手術(shù),復(fù)發(fā)率4%;(5)2組均未發(fā)生腦脊液漏、感染、神經(jīng)根損傷等嚴重并發(fā)癥;(6)綜上,腰椎間盤摘除后同時行纖維環(huán)裂口縫合術(shù)創(chuàng)傷小,重建了椎間盤的完整結(jié)構(gòu),可有效防止髓核再突出,具有可行性與有效性,臨床療效滿意。
[Abstract]:Background: studies have shown that fiber ring suture after nucleus pulposus extirpation can achieve good curative effect and reduce recurrence rate, but there are few reports of effective repair methods and reliable repair instruments. Objective: to observe the clinical effect of suture repair of annulus fibrosus after nucleus pulposus extirpation of lumbar disc protrusion under expandable spinal minimally invasive channel. Methods: from August 2013 to August 2015, 50 patients with lumbar disc protrusion were randomly divided into two groups. 25 patients in suture group underwent annulectomy after nucleus pulposus extirpation, and 25 patients in control group underwent nucleus pulposus extraction alone. The length of incision, operation time and blood loss during operation were recorded and compared. The visual analogy score of Oswestry dysfunction score (ODI), low back pain and lower extremity pain before and after treatment was evaluated, and the complications and recurrence of the operation were observed at the same time. Results and conclusion: (1) 25 patients in the suture group were followed up completely, while only 23 patients in the control group were followed up. (2) there was no significant difference in sex, age and surgical segment between the two groups (P 0.05). (3) the visual analogy score of the two groups was significantly lower than that of the control group at each time point after ODI (P 0.05). Except for the visual analogy score of 1 month after operation, the ODI, of the suture group and the control group were significantly lower than those of the control group before and after operation (P 0.05). There was no significant difference in visual analogy score (P 0.05). (4) in the control group, there were 2 cases of recurrence, of which 1 case was treated with reoperation, the recurrence rate was 9%, 1 case in the suture group was recurrent, and the recurrence rate was 4%. (5) there were no serious complications such as cerebrospinal fluid leakage, infection and nerve root injury in both groups. (6) in summary, the suture of annulus fibrosus after lumbar disc extirpation has little trauma, and the complete structure of intervertebral disc can be reconstructed, which can effectively prevent the reprotrusion of nucleus pulposus, which is feasible and effective, and the clinical effect is satisfactory.
【作者單位】： 湖北省中醫(yī)院骨傷科;
【基金】：湖北省中醫(yī)院科研課題資助項目(JDZX2014Q06)~~
【分類號】：R687.3

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