Comparison of Outcome Using Three Methods of Treatment for Intervertebral Lumbar Disc Disease

腰椎椎間盤突出之三種治療方法的成效比較

董福義(Fu-I Tung) ； 陳弘毅(Hung-Yi Chen) ； 林志(Chih Lin)

《北市醫學雜誌》 3卷1期 (2006/01) Pp. 18-26

https://doi.org/10.6200/TCMJ.2006.3.1.03

摘要

目的：腰椎椎間盤突出症的治療結果仍存在一些令人不滿意之處。方法：我們收集從1994年到1999年間以三種不同手術方法治療腰椎椎間盤突出症之病例共55例，來比較其臨床症狀與X光追蹤之結果與併發症，這三種方法分別是傳統的椎間盤切除(discectomy)，後外側融合(PLF)，與後側腰椎椎體間融合(PLIF)。我們藉由問卷來評估包含下背痛及坐骨神經痛之解除程度，回復工作之能力，復發之症狀及再次手術之病史；藉由比較術前與術後之X光來評估椎間盤高度之變化，椎體間之不穩定與脊椎滑脫之現象。結果：我們分析這三種手術方法之間其結果的差異，發現椎間盤切除組的病患有最高的的再手術發生率(18%)，且都是因為椎間盤突出復發並且其術後症狀較差，與椎間盤高度喪失最多。後外側融合組有較好的術後症狀但有較多的接合處問題(junctional problem)。後側腰椎椎體間融合組有最穩定的結構但術後症狀持平。結論：因此三種方法中並沒有一個絕對優勢的結果。

關鍵字

腰椎 ； 椎間盤突出 ； 椎間盤切除 ； 後外側融合 ； 後側腰椎椎體間融合

並列摘要

Background and Purpose: There are controversies with treatment for intervertebral disc disease of the lumbar spine. Methods: We performed 3 surgical methods for intervertebral lumbar spine disc disease during the period 1994 to 1999. Clinical and radiological follow-up data were obtained to compare the results and sequential complications. The methods were a traditional discectomy (38 patients), posterolateral fusion (PLF; 6 patients), and posteriorlumbar interbody fusion (PLIF; 11 patients). Fifty-five patients who underwent surgery and for whom postoperative lumbar spinal X-ray films were obtained completed questionnaires regarding pain relief, recovery to work ability, recurrent symptoms, and the need for a reoperation. Disc height change, segmental instability, and spondylolisthesis were determined by comparing the pre- and postoperative X-ray films. Results: Clinical and radiological outcomes were compared between groups undergoing the 3 operative methods. In the discectomy group, 18% required a reoperation, due in all cases to recurrence of disc herniation. The worst postoperative symptoms and greatest disc height loss were also noted in this group. PLF group patients had fewer postoperative symptoms, yet more junction problems were noted radiologically. Conclusion: PLIF group patients had the best stability but only fair improvement in postoperative symptoms. None of the 3 methods was superior to the other methods in terms of surgical outcomes.

並列關鍵字

lumbar ； disc ； discectomy ； posterolateral fusion ； posterior lumbar interbody fusion