国立病院機構50施設の共同研究―腰椎椎間板ヘルニアの疫学調査

Etiology in Operative Cases with Herniated Lumbar Disc at 50 Institutes of National Hospital Organization. A Multicenter Study

　腰椎椎間板ヘルニアに対する国内での多施設共同研究の報告がないため，国立病院機構50施設での疫学調査を行い，手術症例数を把握すると同時に術式の変遷，再発率について検討した．2004年の1年間の手術症例数は811例で，手術時年齢は30歳代にピークがあるものの，以前の報告に比べ60歳以上の高齢者に多くの手術が行われていた．手術術式は68.1％が直視下手術であったが，内視鏡や顕微鏡を用いた鏡視下手術が31.1％に行われていた．再手術は直視下手術が4.2％であるのに対し，鏡視下手術は2.2％と少なかった．病態の違いはあるものの，高齢者のヘルニア手術例の増加は活動性のある高齢者の増加のためと考えられる．

　The study was designed as a retrospective review of patients who had undergone their first operation for a herniated lumbar disc at 50 hospitals of the National Hospital Organization in 2004.　Age, operative method, and whether repeat surgery was performed were reviewed.　A total of 811 patients had undergone their first operation.　Their average age was 46.3 years old (range：12-87).　The highest incidence rate was in the third decade, and, the incidence rate in aged patients more than 60 years was 25.6%.　Standard discectomy (68.1%) was gradually being replaced by the microdiscectomy (31.1%).　The rate of repeat surgery was 4.2% after standard discectomy and 2.2% after microscopic discectomy.　The results of this study showed a higher proportion of elderly patients, especially of patients over 60 years old, than in previous reports.　The increase may be due to increased activity by the aged.