腰椎间盘突出症治疗的循证医学综述.docVIP

腰椎间盘突出症治疗的循证医学综述 Treatment of Lumbar Disc Herniation: An Evidence-Based Review 腰椎间盘突出症治疗的循证医学综述 Wayne Moschetti, MD, Adam M. Pearson, MD, MS, and William A. Abdu, MD, MS Several randomized controlled trials (RCTs) and prospective observationeil cohort studies have compared surgical to conservative treatment for patients wi th sciatica caused by lumbar disc herniatione Whereas no RCT has been able to compare surgery with nonop^erative treatment wi thout substantial crossover between treatment. groups, multiple RCTs and observational studies have suggested that surgery resulted in faster improvement and a greater degree of improvement compared with nonoperative treatment? However, many patients in these studies al so experienced improvement wi th nonoperati ve care wi thout adverse sequelae? This paper critically reviews the literature comparing surgery with nonoperative treatment for lumbar disc herniation. Semin Spine Surg 21:223-229 ? 2009 Elsevier Inc. All rights reserved. KEYWORDS Maine lumbar spine study, Spine Patient Outcomes Research Trial, sciatica, intervertebral disc herniation, low back pain, lumbar disc herniation 对于腰椎间盘突出导致的坐骨神经痛，有儿项随机对照试验(RCTs)和前瞻性的观察队 列研究对于术和保守治疗进行了比较。尽管H前还没有RCT能对于?术和非于术治疗进行没 有任何组间交叉的比较，多项RCT和观察研究都认为与非手术治疗相比，手术可以获得更 快、更人程度的改善。然而，在这些研究小很多患者通过非手术治疗也获得了改善，并且 没有导致不良的后果。木文对文献进行审慎的综述，以对腰椎间盘突出症的手术和非手术 治疗进行比较。 关键词缅因州腰椎研究；脊柱患者治疗结果研究试验；坐骨神经痛；椎间盘突出；腰 痛；艘椎间盘突出 ciaties is defined as pain radiating in an area of the leg that is served by a single nerve root in the lumbar or sacral spine and may be associated with motor or sensory deficits. A 1 umbar intervertebral disc hern i at ion (IDH) is the most comnnon cause of sciatica in working aduIts, with an estimated annual incidence of 5 per 1000 aduIts. 1,2 Diskectomy is the most common lumbar spine surgery, and more than 250,000 elective lumbar spine surgeries occur each year in the USA. 3 Many patients with sciatica will improve over time, yet sur^gery is frequent 1y considered for patients wi th se