摘要
目的 以社会统计资料、病程、临床症状、神经体征和影像表现五个方面作为显微内镜椎间盘髓核摘除术(MED)治疗腰椎间盘突出症效果的预测因素,并评价其价值。方法 对198例首次接受单节段MED腰椎间盘突出症患者,进行前瞻性观测研究,患者平均年龄37.6岁(24-62岁)。制定腰椎间盘突出症选择MED手术的客观评价系统,以社会统计资料、病程、症状、神经体征和影像表现的各项分值计算总分,单项最高3分,满分34分。通过随访检查评价临床结果,进行结果和预测分值间的比较。结果 术后平均随访12.5个月,采用改良MacNab标准评定临床结果,152例(76.8％)患者达优,34例(17.2％)良,8例(4％)可,4例(2％)差。优组患者MED手术疗效预测因素评分平均27.1分,良组23.3分,可组19.8分,差组14.2分,各组间比较差异显著(P<0.01)。结论 根据预测计分,MED应选择预计结果优或良的患者,其他患者需再次考虑手术指征。
Objective To evaluate the prognostic value of sociodemographic data, duration of disease, clinical symptom, neurologic signs and imaging findings on outcome of lumbar disc hemiation treated with microendoscopic discectomy ( MED). Methods A prospective study of 198 consecutive patients (aged 24-62 years with a mean of 37.6 years) undergoing single level primary lumbar MED was conducted. An objective rating system for the patient with disc herniation treated with lumbar MED was presented. Based on the findings within each of five categories (sociodemographic data, history of disease, symptom, neurologic signs, imaging findings) , numeric scores were derived. A maximum of 3 points was available in each category with a total of 34 points. Clinical outcomes were evaluated by the examinations during follow-up. Comparisons between clinical results and predictive scores were made. Results The average duration of follow-up was 12. 5 months after surgery. Clinical outcomes were determined using a modified MacNab criteria. Overall, 152 (76.8% ) of 198 patients were rated as excellent ( mean score was 27.1 points) , 34 (17.2% ) were good (mean score was 23.3 points), 8 (4% ) were fair (mean score was 19.8 points) and 4 (2% ) were poor (mean score was 14. 2 points). Conclusion Lumbar microendoscopic discectomy should only be performed to the patients who can be rated as excellent or good according to their predictive scores. Otherwise, the operative approach should be reconsidered. If a poor outcome is predicted, conservative and psychological treatment are not suggested.
出处
《脊柱外科杂志》
2004年第3期129-132,共4页
Journal of Spinal Surgery
