摘 要
腰椎间盘突出症是导致腰腿痛的常见病因，传统开放手术作为经典治疗手段在临床实践中仍具有重要地位。本研究旨在系统评估传统开放手术治疗腰椎间盘突出症的临床疗效及安全性，并探讨其适应证的优化策略。研究采用回顾性队列研究方法，选取2018年1月至2022年12月期间在本院接受传统开放手术治疗的腰椎间盘突出症患者368例，通过对比术前、术后3个月、6个月及1年的视觉模拟评分、Oswestry功能障碍指数及日本骨科协会评分等指标，评估手术效果。同时记录术中出血量、手术时间、住院时间及并发症发生率等安全性指标。结果显示，术后各随访时间点VAS评分较术前显著降低，ODI指数由术前的68.5±7.2降至术后1年的18.3±4.6，JOA评分由术前的9.2±2.1提升至术后1年的25.6±3.4。平均手术时间为85±15分钟，术中出血量为150±50ml，住院时间为7.5±1.5天。主要并发症包括硬膜撕裂（2.4%）、神经根损伤（1.1%）和切口感染（0.8%）。
关键词：腰椎间盘突出症;传统开放手术;临床疗效
Abstract
Lumbar disc herniation is a common cause of lumbar and leg pain, and traditional open surgery is still important in clinical practice. This study aims to systematically evaluate the clinical efficacy and safety of traditional open surgery for lumbar disc herniation and to explore the optimization strategy for its indications. In a retrospective cohort study, 368 patients with lumbar disc herniation undergoing traditional open surgery from January 2018 to December 2022 were compared with preoperative, 3 months, 6 months and 1 year. Safety indicators such as intraoperative blood loss, operation time, hospital stay and complication rate were also recorded. The results showed that the VAS score at each follow-up time point was significantly reduced compared with the preoperative score, the ODI index decreased from 68.5 ± 7.2 to 18.3 ± 4.6 one year, and the JOA score increased from 9.2 ± 2.1 to 25.6 ± 3.4 one year. The mean operative time was 85 ± 15 minutes, the intraoperative bleeding volume was 150 ± 50ml, and the hospital stay was 7.5 ± 1.5 days. Major complications included dural tears (2.4%), nerve root injury (1.1%), and incisional infection (0.8%).
Keywords：Lumbar disc herniation; traditional open surgery; clinical efficacy
目 录
引 言 1
第一章 腰椎间盘突出症的病理机制与诊断 2
1.1 腰椎间盘突出症的解剖学基础 2
1.2 腰椎间盘退变的病理生理过程 2
1.3 腰椎间盘突出症的临床表现 3
第二章 传统开放手术的发展历程与技术特点 4
2.1 传统开放手术的历史沿革 4
2.2 椎板切除术的技术要点分析 4
2.3 椎间盘切除术的适应证与禁忌证 5
第三章 传统开放手术的临床疗效评估 6
3.1 术后疼痛缓解的量化评价 6
3.2 神经功能恢复的长期随访研究 6
3.3 患者生活质量的改善程度分析 7
3.4 不同术式疗效的比较研究 7
第四章 传统开放手术的优化策略与发展趋势 9
4.1 微创理念在传统手术中的应用探索 9
4.2 术中导航技术的辅助应用价值 9
4.3 术后康复方案的优化设计 10
4.4 传统开放手术的未来发展方向 11
结 论 12
参考文献 13
致 谢 14
腰椎间盘突出症是导致腰腿痛的常见病因，传统开放手术作为经典治疗手段在临床实践中仍具有重要地位。本研究旨在系统评估传统开放手术治疗腰椎间盘突出症的临床疗效及安全性，并探讨其适应证的优化策略。研究采用回顾性队列研究方法，选取2018年1月至2022年12月期间在本院接受传统开放手术治疗的腰椎间盘突出症患者368例，通过对比术前、术后3个月、6个月及1年的视觉模拟评分、Oswestry功能障碍指数及日本骨科协会评分等指标，评估手术效果。同时记录术中出血量、手术时间、住院时间及并发症发生率等安全性指标。结果显示，术后各随访时间点VAS评分较术前显著降低，ODI指数由术前的68.5±7.2降至术后1年的18.3±4.6，JOA评分由术前的9.2±2.1提升至术后1年的25.6±3.4。平均手术时间为85±15分钟，术中出血量为150±50ml，住院时间为7.5±1.5天。主要并发症包括硬膜撕裂（2.4%）、神经根损伤（1.1%）和切口感染（0.8%）。
关键词：腰椎间盘突出症;传统开放手术;临床疗效
Abstract
Lumbar disc herniation is a common cause of lumbar and leg pain, and traditional open surgery is still important in clinical practice. This study aims to systematically evaluate the clinical efficacy and safety of traditional open surgery for lumbar disc herniation and to explore the optimization strategy for its indications. In a retrospective cohort study, 368 patients with lumbar disc herniation undergoing traditional open surgery from January 2018 to December 2022 were compared with preoperative, 3 months, 6 months and 1 year. Safety indicators such as intraoperative blood loss, operation time, hospital stay and complication rate were also recorded. The results showed that the VAS score at each follow-up time point was significantly reduced compared with the preoperative score, the ODI index decreased from 68.5 ± 7.2 to 18.3 ± 4.6 one year, and the JOA score increased from 9.2 ± 2.1 to 25.6 ± 3.4 one year. The mean operative time was 85 ± 15 minutes, the intraoperative bleeding volume was 150 ± 50ml, and the hospital stay was 7.5 ± 1.5 days. Major complications included dural tears (2.4%), nerve root injury (1.1%), and incisional infection (0.8%).
Keywords：Lumbar disc herniation; traditional open surgery; clinical efficacy
目 录
引 言 1
第一章 腰椎间盘突出症的病理机制与诊断 2
1.1 腰椎间盘突出症的解剖学基础 2
1.2 腰椎间盘退变的病理生理过程 2
1.3 腰椎间盘突出症的临床表现 3
第二章 传统开放手术的发展历程与技术特点 4
2.1 传统开放手术的历史沿革 4
2.2 椎板切除术的技术要点分析 4
2.3 椎间盘切除术的适应证与禁忌证 5
第三章 传统开放手术的临床疗效评估 6
3.1 术后疼痛缓解的量化评价 6
3.2 神经功能恢复的长期随访研究 6
3.3 患者生活质量的改善程度分析 7
3.4 不同术式疗效的比较研究 7
第四章 传统开放手术的优化策略与发展趋势 9
4.1 微创理念在传统手术中的应用探索 9
4.2 术中导航技术的辅助应用价值 9
4.3 术后康复方案的优化设计 10
4.4 传统开放手术的未来发展方向 11
结 论 12
参考文献 13
致 谢 14
