椎间盘镜治疗70岁以上老年椎间盘突出症  

Micro-endoscopic discectomy for the treatment of lumbar disc herniation in senile patients over seventy years old

作　　者：赵刘军[1] 蒋伟宇[1] 马维虎[1] 徐荣明[1] 孙韶华[1] 

机构地区：[1]宁波市第六医院脊柱外科,浙江宁波315040

出　　处：《中国骨伤》2011年第10期811-815,共5页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨椎间盘镜治疗老年椎间盘突出症的临床疗效和适用范围。方法:2007年12月至2010年6月,采用METRxⅡ椎间盘镜系统治疗70岁以上老年椎间盘突出症患者32例,其中男20例,女12例;年龄70～86岁,平均78.5岁;病程2周～30年,平均3.5年。患者主要以腰痛伴有明显下肢放射痛,疼痛多数位于膝关节以下。术后对患者的手术时间、出血量、并发症及临床症状进行观察。术后1周拍X线片比较手术前后患者腰椎生理曲度改变情况;术后1个月通过MRI比较患者术前术后影像学变化;术后3个月按照MacNab标准对疗效进行评定。结果:所有患者手术顺利,均获得随访,时间3～30个月,平均12.5个月。手术时间为30～120min,平均65min。术中出血量15～150ml,平均45ml。1例患者术中出现脑脊液漏,用脑棉压迫后继续手术。术中无神经根、血管损伤发生。1例患者清醒后症状加重,其余患者症状均有缓解。术后1周X线片提示25例患者生理屈度改善。术后1个月MRI提示8例患者仍然可见椎间盘或钙化组织部分残留。11例患者主诉患肢尚有少许麻木,但疼痛酸胀明显好转。术后3个月按照MacNab标准评定疗效:优25例,良6例,可1例。结论:椎间盘镜治疗老年椎间盘突出症能使患者早期下床活动,具有创伤小、出血少、疗效好的临床特点,适用于伴有明显下肢放射痛,膝关节以下疼痛为主,又无明显腰椎不稳的患者,对伴有轻中度椎管狭窄及根管狭窄的患者可同时处理。Objective：To explore applicability and therapeutic effects of Micro-endoscopic discectomy（MED） for the treatment of lumbar disc herniation in senile patients over seventy years old.Methods：Thirty-two patients over seventy years old with lumber disc herniation were treated by MED from December 2007 to June 2010.Among them,20 patients were male and 12 patients were female,ranging in age from 70 to 86 years,with an average of 78.5 years old.The course of diseases ranged from 2 weeks to 30 years,with an average of 3.5 years.The main clinical symptoms were low back pain with radiating pain in lower extremities,especially under the keen joint.The surgical time,blood loss,complications and function recovery were evaluated retrospectively immediately after operation.X-ray at 1 week after operation was used to observe the change of physical curvature of lumbar;MRI at 1 month after operation was used to observe the radiographic change of lumbar before and after treatment;MacNab standard was applied to evaluate the therapeutic effects at 3 months after operation.Results：The mean follow up period was 12.5 months（from 3 to 30 months）.The mean operative time was 60 min（from 30 to 120 min） and the mean blood loss was 45 ml（from 15 to 150 ml）.Leakage of cerebrospinal fluid occurred in 1 case,the operation continued after pressing by brain cotton and without nerve root and vessels injury;1 case aggravated after revive,but other patients were eased.X-ray at 1 week after operation showed physical curvature of lumbar of 25 patients improved;MRI at 1 month after operation showed residue intervertebral disc and calcification tissue in 8 cases.Eleven patients still had numbness of limbs,but the pain and tenderness of limbs relieved.According to MacNab standard at 3 months after operation,25 cases got an excellent result（78.1%）,6 good（18.8%） and 1 fair（3.1%）.Conclusion：MED is effective for the senile patients over 70 years old with lumbar disc herniation and promotes ambulation earlier.MED has the adv

关 键 词：腰椎 椎间盘移位 内窥镜 外科手术 微创性 

分 类 号：R681.53[医药卫生—骨科学]