| 非手术治疗破裂型腰椎间盘突出症5年随访研究 |
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投稿时间：2019-04-15
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| 作者 | Author | 单位 | Address | E-Mail |
| 戴锋 |
DAI Feng |
南京中医药大学苏州附属医院 苏州市中医医院, 江苏 苏州 215009 |
The Affiliated Hospital of Nanjing University of Chinese Medicine, Suzhou Hospital of Traditional Chinese Medicine, Suzhou 215009, Jiangsu, China |
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| 俞鹏飞 |
YU Peng-fei |
南京中医药大学苏州附属医院 苏州市中医医院, 江苏 苏州 215009 |
The Affiliated Hospital of Nanjing University of Chinese Medicine, Suzhou Hospital of Traditional Chinese Medicine, Suzhou 215009, Jiangsu, China |
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| 刘锦涛 |
LIU Jin-tao |
南京中医药大学苏州附属医院 苏州市中医医院, 江苏 苏州 215009 |
The Affiliated Hospital of Nanjing University of Chinese Medicine, Suzhou Hospital of Traditional Chinese Medicine, Suzhou 215009, Jiangsu, China |
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| 姜宏 |
and JIANG Hong |
南京中医药大学苏州附属医院 苏州市中医医院, 江苏 苏州 215009 |
The Affiliated Hospital of Nanjing University of Chinese Medicine, Suzhou Hospital of Traditional Chinese Medicine, Suzhou 215009, Jiangsu, China |
honghong751@126.com |
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| 期刊信息：《中国骨伤》2020年，第33卷，第5期，第414-419页 |
| DOI：10.12200/j.issn.1003-0034.2020.05.005 |
| 基金项目:苏州市科技局资助（编号：sysd2017131） |
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中文摘要:
目的：探讨非手术治疗破裂型腰椎间盘突出症的近中期疗效及预后转归。
方法：选取2011年2月至2014年2月接受非手术治疗的75例单节段破裂型腰椎间盘突出症患者进行前瞻性研究，男53例，女22例；年龄18~58（35.62±9.96岁）；病程5 d~6个月，平均（46.45±40.66）d。突出节段：L3，4 4例，L4，5 29例，L5S1 42例。放射痛左侧46例，右侧29例。选取治疗前，治疗后3个月、6个月、1年、2年、5年6个时间点对患者JOA评分、直腿抬高角度（SLRT）、指地距统计分析。计算末次随访时（治疗后5年）JOA改善率，根据JOA评分评定疗效；分析治疗前、末次随访（治疗后5年）椎间盘突出物体积变化，计算突出物体积吸收率，观察突出物吸收情况；分析JOA改善率与突出物吸收率之间关系。
结果：71例患者完成随访，非手术治疗后3个月、6个月、1年、2年、5年JOA评分、SLRT、指地距与治疗前比较，差异有统计学意义（P<0.05）。治疗后5年与6个月、治疗后5年与2年、治疗后2年与6个月JOA评分比较，差异无统计学意义（P>0.05），其余各时间点两两比较，差异均有统计学意义（P<0.05）；治疗后5年与6个月、治疗后5年与2年、治疗后2年与6个月SLRT、指地距比较，差异亦无统计学意义（P>0.05），其余各时间点两两比较，差异均有统计学意义（P<0.05）。末次随访JOA改善率为（62.69±2.47）%，按照JOA评分评定疗效，结果优26例，良26例，可14例，差5例，优良率73.24%；突出物体积由起始的（1 981.73±588.72）mm3减少至（1 011.82±395.47）mm3，总体吸收率（45.65±2.83）%，突出物发生明显吸收24例，部分吸收26例，未吸收19例，增大2例。JOA改善率与突出物吸收率作Spearman秩相关分析，发现两者呈中等以上正相关（r=0.679，P<0.001）。
结论：非手术治疗破裂型腰椎间盘突出症可取得良好疗效，明确了破裂型腰椎间盘突出症的病情特点及预后转归，同时部分患者发生"重吸收"现象。 |
| 【关键词】腰椎间盘突出症 破裂型 非手术 重吸收 |
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| A 5-year follow-up study on non-surgical treatment of ruptured lumbar disc herniation |
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ABSTRACT
Objective: To investigate the short-term and mid-term efficacy with non-surgical treatment and to predict the long-term outcomes of ruptured lumbar disc herniation.
Methods: From February 2011 to February 2014,75 patients with single-segment ruptured lumbar disc herniation treated by non-surgical therapy were selected for prospective study. There were 53 males and 22 females,aged from 18 to 58(35.62±9.96) years old. The course of disease was from 5 days to 6 months,with an average of (46.45±40.66) days. The lesions were located at L3,4 in 4 cases,at L4,5 in 29 cases,at L5S1 in 42 cases. Radiation pain in 46 cases on the left and 29 cases on the right. The JOA score,straight leg raising test angle and finger-to-ground distance were assessed pretreatment and at 3 months,6 months,1 year,2 years and 5 years after treatment. The improvement rate of JOA at the final follow-up(5 years after treatment) was calculated and the curative effect according to JOA score was evaluated;the volume change of protrusion before treatment and at the final follow-up (5 years after treatment) was analyzed,the volume absorption rate of protrusion was calculated and the absorption of protrusion was observed;the relationship between the improvement rate of JOA and the absorption rate of protrusion were analyzed.
Results: Seventy-one patients were finally followed up at 5 years after non-surgical treatment. The JOA score,straight leg raising test angle and finger-to-ground distance at 3 months,6 months,1 year,2 years and 5 years after treatment were significantly improved(P<0.05). There was no significant difference in JOA scores between 5 years and 6 months after treatment,5 and 2 years after treatment,and 2 years and 6 months after treatment(P>0.05). There was significant difference in other time points(P<0.05). The results of the straight leg raising test angle and the finger-to-ground distance were similar to the JOA scores. The improvement rate of JOA score was (62.69±2.47)% at the final follow-up. According to JOA score,the results were excellent in 26 cases,good in 26 cases,fair in 14 cases,poor in 5 cases,and the excellent and good rate was 73.24%. The volume of protrusion decreased from(1 981.73±588.72) mm3 to(1 011.82±395.47) mm3,the total absorption rate was (45.65±2.83)%,the protrusion was obviously absorbed in 24 cases,partially absorbed in 26 cases,not absorbed in 19 cases,and increased in 2 cases. It was found that there was a positive correlation between improvement rate of JOA scores and protrusion absorption rate at 5 years after non-surgical treatment(r=0.679,P<0.001).
Conclusion: Non-surgical treatment of ruptured lumbar disc herniation can achieve good results,clear the characteristics of the ruptured lumbar disc herniation and prognosis,and some patients have "reabsorption" phenomenon. |
| KEY WORDS Lumbar disc herniation Ruptured Non-surgical Resorption |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 戴锋,俞鹏飞,刘锦涛,姜宏.非手术治疗破裂型腰椎间盘突出症5年随访研究[J].中国骨伤,2020,33(5):414~419 |
| 英文格式: | DAI Feng,YU Peng-fei,LIU Jin-tao,and JIANG Hong.A 5-year follow-up study on non-surgical treatment of ruptured lumbar disc herniation[J].zhongguo gu shang / China J Orthop Trauma ,2020,33(5):414~419 |
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