后路减压椎间融合治疗腰椎间盘突出症术后复发.DOC

后路减压椎间融合治疗腰椎间盘突出症术后复发临床疗效研究 沈俊 孔维清 徐建广 柴益民 张长青 （上海交通大学附属第六人民医院骨科 宜山路600号 200233 ） 摘要 目的 研究后路减压椎间融合（PLIF手术）治疗腰椎间盘突出症（LDH）髓核摘除或微创手术术后复发患者的临床疗效以及2年随访结果。方法 从2007年1月-2012年6月PLIF手术治疗LDH术后复发并得到随访56例患者。根据主要症状将患者分为腰腿痛型（A型），下肢麻木伴放射感型（B型），腰腿痛伴下肢麻木型（C型）。术前，术后3月，6月，12月，2年评估患者腰椎JOA评分，腰椎ODI指数以及腰腿痛VAS评分。结合MacNab临床疗效分析标准分析三组疗效情况。结果 A B C三型患者术后2年患者均有好转，2年随访JOA评分以及改善率A型最佳，效果为良；C型患者次之，效果为一般，B型患者最差，效果为差。结合改良的MacNab疗效评定标准，A型全部患者症状减轻，B型88.9%的患者症状减轻，C型93.1%的患者症状减轻。 结论 A型以及C型患者建议尽早手术，B型患者保守治疗无效后，和患者充分沟通后考虑手术。 关键词 腰椎间盘突出症复发 临床疗效 后路椎间融合 Clinical outcomes of posterior lumbar interbody fusion for recurrent lumbar disc herniation after discectomy SHEN Jun,KONG Weiqing,XU Jianguang,CHAI Yimin,ZHANG Changqing. Department of Orthopedics, Shanghai Jiaotong University Affiliated Sixth Peoples Hospital, No.600, Yishan Rd, Shanghai, 200233, China. Corresponding author: KONG Weiqing－Email: wqkong100@126.com Abstract Objective To compare 2-year follow-up results of clinical outcomes of recurrent lumbar disc herniation after posterior lumbar interbody fusion(PLIF). Methods 56 patients with recurrent lumbar disc herniation received PLIF from January 2007 to June 2012 in our hospital. They were divided into three groups according to symptoms: Group A (only lumbocrural pain); Group B (Lower extremity numbness accompanied by sciatica); Group C (lumbocrural pain accompanied by Lower extremity numbness). Analysis of clinical outcomes among three groups was made according to the Japanese Orthopaedic Association Scores, Visual Analogue Scale , Oswestry Dability Index and MacNab scores recorded during the long-term follow-up period (3 months, 6 months, 12 months, 24 months later after operation ). Results The results revealed the improvement of all groups in sequence. All patients in Group A felt better after operations and achieved the best results. 93.1% patients in Group B got better results. Patients in Group C had least effective recovery and 88.9% patients gave positive results. Conclusion Pati