腰椎间盘镜治疗老年性腰神经根管狭窄症的手术疗效

目的: 探讨腰椎间盘镜治疗老年性腰神经根管狭窄症的适应证、手术方法及术后疗效. 方法: 自2007年3月至2010年10月,采用腰椎间盘镜下后路椎管开窗减压术治疗56例老年性腰神经根管狭窄患者,其中男38例,女18例;年龄61～76岁,平均(64.53±4.43)岁;病程6个月～15年. 手术前后根据日本矫形外科学会(JOA)腰痛评分 29 分法(包括主观症状、客观体征、膀胱功能)对功能进行评分,评估术后1、3、6、12个月的临床疗效,并摄X线片进行影像学评估. 结果: 51例患者获得随访,时间1～12个月,术后1、3、6个月及1年的JOA评分由术前的13.46±2.02,分别提高到23.13±1.86、23.54±2.39、24.66±1.57、24.83±1.74,末次随访时JOA评分与术前比较差异有统计学意义(P<0.05),术后1、3、6、12个月的优良率分别为83.92%、90.74%、95.42%、92.15%.影像学检查没有发现腰椎失稳现象. 结论: 腰椎间盘镜开窗根管减压术治疗老年性腰神经根管狭窄症是一种有效的术式,具有手术创伤小、术后恢复快的特点,合适的适应证选择和精细的操作是手术成功的关键.

Treatment of senile lumbar nerve root canal stenosis with micro-endoscope discectomy

Objective: To investigate the indication,surgical techniques and clinical effect of micro-endoscope discectomy(MED)in treating senile lumbar nerve root canal stenosis. Methods: From March 2007 to October 2010,56 patients with lumbar nerve root canal stenosis were treated with discectomy and decompression through micro-endoscope. There were 38 males and 18 females,aged 61 to 76 years old with an average of (64.53±4.43) years old. Course of disease was from 6 months to 15 years. According to JOA 29 score system,the function was evaluatd before and after operation,including subjective symptom,objective sign and bladder function. At 1,3,6,12 months after operation,according to X-rays examination to analyze,the clinical effects were analyzed. Results: Fifty-one patients were followed up from 1 to 12 months. At 1,3,6,12 months after operation,JOA score improved from preoperative 13.46±2.02 to 23.13±1.86,23.54±2.39,24.66±1.57,24.83±1.74,respectively;and the rate of excellent and good was 83.92%,90.74%,95.42%,92.15%,respectively. There was statistical significance in JOA score between preoperative and final follow-up(P<0.05). No lumbar instability sign was found by X-rays examination. Conclusion: Nerve root canal decompression through micro-endoscope discectomy for the treatment of senile lumbar nerve root canal stenosis is an effective procedure,which has the advantages of less traumatic,rapid recovery,but selection of indication and accurate operation are main keys.