腰椎间盘突出症79例术后疗效的临床视察.pdf

提 要 目的：观察不同手术方式治疗腰椎间盘突出症(Lumbar disc herniation，LDH) 术后疗效的差别，并分析影响术后疗效的因素，总结治疗经验，更好地指导临床，提 高疗效。方法：本研究通过对 79 例患者作回顾性分析，分为开窗髓核摘除术组（A 组）和椎板切除髓核摘除术组（B 组）。比较术前和术后（12 个月时）JOA 评分，计 算 JOA 评分改善率,从而对手术疗效进行评估。采用统计学方法分析 JOA 评分改善率 与年龄、手术节段数、体质指数(BMI)和术后功能锻炼的关系，从而说明术后疗效和 以上因素的关系。结果：所有患者于术后 12 个月时随访，两组 JOA 评分分别从术前 的 12.63±2.06 分和 12.17±1.84 分提高到术后的 24.63±1.51 分和 23.71±1.64 分，各组术前、术后评分有非常显著性差异（P＜0.01），两组临床总疗效比较无显著 性差异（P＞0.05）。对于不同年龄患者，术后疗效无显著差异。对于体质指数，正常 组的JOA改善率比肥胖组高。对于手术节段数目不同患者，术后疗效无显著差异。能 够坚持术后功能锻炼（≥6 个月）的患者，JOA 改善率较高。患者自我满意程度中， 很满意和满意者共达94.94％。结论：(1)手术治疗腰椎间盘突出症的疗效是肯定的。 (2) 两组治疗的效果无明显差别。(3) 腰椎间盘突出症的术后疗效与年龄、手术节段 数目无关，与体重指数(BMI)和术后功能锻炼有密切的关系。(4)术后积极、合理和早 期的康复训练是取得良好治疗效果的保障。 关键词 腰椎间盘突出症；手术；临床观察 Clinical Observation on the Postoperative Results of 79 Cases with Lumbar Disc Herniation Specialty: Orthopedics of TCM Student: Xu Peng Tutor: Prof. Wang Mingxi Abstract Objective: The clinical postoperative results of different operation models for Lumbar Disc Herniation (LDH) were observed and analyzing the correlated characters of the postoperative results on LDH to direct the clinical practices. Methods: 79 cases were divided into two groups: the group of the fenestration lumbar discectomy (A group) and the group of the semi-laminectomy or total-laminectomy (B group).They were analyzed retrospectively to calculate the improvement of JOA scores and evaluated the treatments. Correlations between improvement of JOA scores and age at the operation, number of lumbar discs in treatment, body mass index (BMI), postoperative rehabilitation were investigated by statistical analysis. Result: 79 patients were followed up at 12 months after the operations. After the operation, the JOA score