发信人: penlin(千里不留行)
整理人: coolmanx(2001-12-05 22:26:43), 站内信件
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这篇文章是应tidal的要求写的，其实相关的资料并不难找，因为对于腰椎间盘的治疗，已经进入了一个稳定期。包括对导致腰椎间盘突出的病因，治疗方法和预后，都有很详细的描述。我特地找了基本比较经典的骨科著作，把关于腰椎间盘手术和非手术治疗的疗效的资料摘录于下，希望怀疑手术疗法，夸大非手术疗法之说可以休矣。
material 1:黄家驷外科学 第六版 page2220
1.腰椎间盘绝大部分可经非手术治疗而愈，其方法包括牵引、推拿、按摩和硬膜外皮质醇注射疗法等.上述治疗后较长时间卧床休息甚为重要。
2.手术疗法：有10%至18％经非手术疗法无效后需手术治疗，以下是手术指征：
A:病史超过半年经严格非手术疗法无效，或有效但仍常复发且症状较重者。
B：首次发病，症状严重尤以下肢症状为著
C:中年病人病史较长，影响工作和生活
D:马尾神经综合征或单根神经麻痹
E:CT、MR、椎管造影等证实巨大椎间盘突出
F：椎间盘突出并其他原因所致的椎管狭窄
material 2:实用骨科手术学（主编：蓝文正、郭巨灵）page:1165
非手术疗法能减轻或治愈不少病例，但仍有约50%的病例未愈或愈后复发，最后不得不手术。
手术疗法早在1943年Mixter和Barr开始采用，并获得成功，也取得良好效果。
手术适应症：与黄家驷外科学相类似，而且还特别指出：有先天性脊椎发育畸形和年纪较大，合并脊椎退行性变应放宽手术指征。
书中特地提到：
1.腰椎间盘突出症是客观存在
2.经非手术疗法治疗无效的病例，进行手术治疗是要求较高，疗效确实而可靠的治疗方法，不能被其他方法所代替。
3.天津医院725例中早期疗效优良的病例，经长期观察（10年以上），其疗效仍属满意，优良率为86％
material 3:Current Diagnosis And Treatment in Orthopedics
About 50% of patients recover within 1 month,and 96% function normally by 6 months.The rate of surgical treatment in the US is three times higher than that in Sweden.
In case of lumbar disk herniation,the goal of treatment is to return the patient to normal activities as quickly as possible.
About 10% of patients with lumbar herniation will ultimatelly require surgery.
When a standard diskectomy is used,the overall success rate is 85%,and 95% of the patients with successful surgery return to work
material 4:Essential orthopedics and trauma
Manipulation of spines with acute disc prolapse is very dangerous.
The concept of 'putting the disc back' by manipulation as if it were a piece of jigsaw is firmly rooted in the public mind and it is quite wrong.
At operation,the disc will usually extrude itself from the disc space under pressure when the annulus fibrosus is excised and to imagine that these discs can be replaced by manipulation is a fallacy. |
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