Martínez Quiñones J V, Aso J, Consolini F, Arregui R
Servicio de Neurocirugía. Hospital MAZ. Zaragoza.
Neurocirugia (Astur). 2011 Jun;22(3):235-44. doi: 10.4321/s1130-14732011000300003.
In the treatment of the lumbar disc herniaton (LDH) microdiscectomy constitutes one of the standard procedures. In the present study we have analyzed the clinical outcome of the lumbar microdis- cectomy in a series of worker patients who underwent surgery in our service.
Retrospective analysis and a 5-year follow up, of a series of 142 patients operated on by means of lumbar microdiscectomy in the 2004-2005 period. The clinical outcome was analyzed according to the "Herron and Turner" outline: pain reduction, use of medical treatment, restriction in the ability to perform physical activities, and return to work.
116 men and 26 women, with an average age of 37.9 and 45.4 years respectively, underwent surgery because of LDH. In the clinical aspect, sciatica was predominant over low back pain in a ratio of three to one. The L5-S1 discal level was operated on in 68.3% of the cases. It was considered that occupational activities gave rise to damage in 107 patients (75.3%). Besides a symptomatic disc, there was an additional injured disc in 44.3% of the cases. An initial unfavourable outcome was seen in 42 patients (33%), 15 of which recovered from in an interval of 3 months, and another fifteen within a one year period. A re-operation was necessa ry in 16 patients because of recurrent lumbar disc herniation (11%). Work reintegration was achieved in 83.3% (119/142) of the cases. After a 5-year follow up, we stated the consistency of the clinical result.
We analyzed the intervertebral disc behaviour as regards sex, age, variety of discal herniation, additional disc, outcome and re-operation variables. After the analysis of the type of discal herniation and additional disc we defined three disc injury patterns. We consider microdiscectomy as the technique of choosing for the treatment of recurrence disc herniation.
Between the working class, discal injury predominates in young men, as a consequence of the annulus breakage, or an annulus plus posterior longitudinal ligament breakage (traumatic herniae). Frequently it was observed that more than one disc was involved, and a left lateralization.
在腰椎间盘突出症（LDH）的治疗中，显微椎间盘切除术是标准手术之一。在本研究中，我们分析了一系列在我院接受手术的工人患者行腰椎显微椎间盘切除术的临床结果。
对2004 - 2005年期间接受腰椎显微椎间盘切除术的142例患者进行回顾性分析及5年随访。根据“赫伦和特纳”大纲分析临床结果：疼痛减轻、药物治疗使用情况、身体活动能力受限情况以及重返工作岗位情况。
116名男性和26名女性因腰椎间盘突出症接受手术，平均年龄分别为37.9岁和45.4岁。在临床方面，坐骨神经痛与下腰痛的比例为三比一，占主导地位。68.3%的病例手术部位为L5 - S1椎间盘水平。107例患者（75.3%）被认为职业活动导致了损伤。除了有症状的椎间盘外，44.3%的病例还存在额外的损伤椎间盘。42例患者（33%）最初预后不佳，其中15例在3个月内恢复，另外15例在1年内恢复。16例患者因复发性腰椎间盘突出症需要再次手术（11%）。83.3%（119/142）的病例实现了重返工作岗位。经过5年随访，我们证实了临床结果的一致性。
我们分析了椎间盘在性别、年龄、椎间盘突出类型、额外椎间盘、预后和再次手术变量方面的表现。在分析椎间盘突出类型和额外椎间盘后，我们定义了三种椎间盘损伤模式。我们认为显微椎间盘切除术是治疗复发性椎间盘突出症的首选技术。
在工人阶级中，由于椎间盘环破裂或椎间盘环加后纵韧带破裂（创伤性疝），年轻男性的椎间盘损伤占主导。经常观察到不止一个椎间盘受累，且向左外侧突出。
