Astrand P, Määttänen H, Vucetic N, Svensson O
Department of Orthopaedics, Karolinska Institutet, Huddinge University Hospital, Sweden.
Clin Orthop Relat Res. 2000 Oct(379):154-60. doi: 10.1097/00003086-200010000-00018.
In a prospective study of 161 consecutive patients with lumbar discectomy, pain, lumbar mobility, and neurologic and root tension signs were followed up for at least 2 years. Sciatica and root tension signs decreased promptly after surgery and remained largely unchanged during followup, which was not the case for neurologic signs. Similarly, pain relief was not associated with neurologic signs but was associated with lumbar mobility and root tension signs. Patients without neurologic symptoms before surgery did not report more sciatica after 2 years than did those with positive neurologic signs before surgery. Positive crossed Lasegue sign and restricted lumbar mobility before surgery predicted better chances for postoperative pain relief. Patients with a ruptured anulus fibrosus at surgery had less sciatica and back pain after surgery than did patients with an intact anulus fibrosus.
在一项对161例连续接受腰椎间盘切除术患者的前瞻性研究中,对疼痛、腰椎活动度以及神经和神经根张力体征进行了至少2年的随访。坐骨神经痛和神经根张力体征在术后迅速减轻,且在随访期间基本保持不变,而神经体征则不然。同样,疼痛缓解与神经体征无关,但与腰椎活动度和神经根张力体征有关。术前无神经症状的患者在2年后报告的坐骨神经痛并不比术前神经体征阳性的患者多。术前阳性的交叉直腿抬高试验和腰椎活动受限预示着术后疼痛缓解的机会更大。手术时纤维环破裂的患者术后的坐骨神经痛和背痛比纤维环完整的患者少。