局麻侧卧位开窗髓核摘除治疗伴心肺合并疾病的老年腰椎间盘突出症  

Treatment of lumbar disc herniation in eldly patients with cardiorespiratory disease by lumbar discectomy in lateral position and local anesthesia

作　　者：王靖[1] 唐天驷[2] 滕红林[1] 朱旻宇[1] 朱雄白[1] 

机构地区：[1]温州医学院附属第一医院骨科,浙江温州325000 [2]苏州大学附属第一医院骨科,江苏苏州215000

出　　处：《临床骨科杂志》2011年第1期9-11,共3页Journal of Clinical Orthopaedics

摘　　要：目的探讨局麻侧卧位开窗髓核摘除治疗伴心肺疾病的老年腰椎间盘突出症的安全性与疗效。方法对12例伴心肺合并疾病的老年腰椎间盘突出症患者在局麻下采用侧卧位开窗髓核摘除治疗,观察术中生命体征、术后心肺合并症等。评估ODI评分与腰痛及腿痛VAS评分。结果术中及术后均未出现心肺功能衰竭等并发症,未出现手术节段错误、神经根或硬膜囊损伤及椎间隙感染等并发症。12例均获随访,时间11～46(27.3±10.7)个月。末次随访时所有患者均恢复正常日常生活。腰痛VAS评分术前为3～6(4.25±1.13)分,术后为1～5(3.33±1.15)分,差异无统计学意义(P>0.05);腿痛VAS评分术前为5～9(6.58±1.31)分,术后为1～5(2.17±1.19)分,差异有统计学意义(P<0.05);ODI评分术前为19～30(25.08±3.32)分,术后为7～17(11.67±3.08)分,差异有统计学意义(P<0.05)。结论局麻侧卧位开窗髓核摘除治疗伴心肺合并疾病的老年腰椎间盘突出症,手术安全性高,并发症少。Objective To evaluate the effeet and security ot lumbar disc herniation in eldly patients with cardiorespiratory disease treated by lumbar discectomy in lateral position and local anesthesia. Methods Twelve eldly patients with insufficiency of cardiorespiratory function who underwent mini-incision lumbar discectomy in lateral position and by local anesthesia were followed up for an average 27.3±10. 7（ 11 -46） months. The clinical results were evaluated according to Oswestry disability index and visual analogue scale score. Results Cardiorespiratory function failure did not occur in all cases. There were no complications such as wrong segment of operation, lesion of nerve root or dura mater and infection of intervertebral space. At the final follow up, every case could lead a normal life, the average VAS score of leg pain was 1 -5（2. 17 ± 1.19） and the average score of ODI was 7 -17 （11.67 ±3.08）, there was significant difference compared with preoperative scores 5 -9 （6. 58 ±1.31 ）and 19 -30 （25.08 ± 3.32）respectively （P 〈 0. 05 ）. But there was no significant difference of the average VAS score of low back pain between preoperation and post operation, 3 -6（4.25 ± 1.13）and 1 ~5（3.33 ±1.15） respectively（P 〉0.05）. Conclusions The mini-incision lumbar discectomy in lateral position by local anesthesia is safe with little complication, and the clinical results are favorable.

关 键 词：麻醉 局部 髓核摘除 老年人 心肺合并疾病 腰椎间盘突出症 

分 类 号：R681.5[医药卫生—骨科学] R54[医药卫生—外科学]