Ito T, Takano Y, Yuasa N
Department of Orthopaedic Surgery, Niigata Cancer Center Hospital, Japan.
Spine (Phila Pa 1976). 2001 Mar 15;26(6):648-51. doi: 10.1097/00007632-200103150-00017.
A retrospective study of different types of herniated discs and duration of symptoms in patients with lumbar disc herniation, and a trial of longer conservative treatment to reduce the number of operations.
To determine whether noncontained and contained herniated discs have different clinical courses and to evaluate the results of the clinical trial of longer and vigorous conservative treatment.
The possibility of a difference in clinical features between contained and noncontained disc herniation has been suggested previously.
In the first study, the medical history and intraoperative findings of 156 patients who had undergone herniotomy were reviewed. In the second study, conservative treatment of at least 2 months' duration was recommended for all patients with lumbar disc herniation.
In the first study, patients with noncontained disc herniation had a shorter preoperative clinical course than those with contained disc herniation. It was rare for noncontained herniation to require surgery 4 months or more after the onset of symptoms. In the second study, the authors' protocol reduced the number of herniotomies required, especially the number of operations for the patients with noncontained disc herniation.
The authors believe that patients with noncontained lumbar disc herniation can be treated without surgery, if these patients can tolerate the symptoms for the first 2 months.
对腰椎间盘突出症患者不同类型的椎间盘突出和症状持续时间进行回顾性研究，并进行更长时间保守治疗以减少手术数量的试验。
确定游离型和包容型椎间盘突出症是否具有不同的临床病程，并评估更长时间积极保守治疗的临床试验结果。
先前已有人提出包容型和游离型椎间盘突出症在临床特征上可能存在差异。
在第一项研究中，回顾了156例行椎间盘切除术患者的病史和术中发现。在第二项研究中，建议所有腰椎间盘突出症患者进行至少2个月的保守治疗。
在第一项研究中，游离型椎间盘突出症患者术前的临床病程比包容型椎间盘突出症患者短。游离型突出症在症状出现4个月或更长时间后很少需要手术。在第二项研究中，作者的方案减少了所需的椎间盘切除术数量，尤其是游离型椎间盘突出症患者的手术数量。
作者认为，如果游离型腰椎间盘突出症患者在前2个月能够耐受症状，则可以不进行手术治疗。
