微创椎间盘切除术治疗老年腰椎间盘突出症34例

目的探讨微创椎间盘切除术治疗老年腰椎间盘突出症的效果。方法选择2010年1月—2014年1月南充市中心医院收治的符合微创椎间盘切除术适应证的老年腰椎间盘突出症34例,行经Quadrant通道微创椎间盘切除术。记录手术时间、术中失血量、手术至开始行走时间、住院时间、住院费用;分别于术后第1、2、3、6个月随访1次,之后每半年随访1次。术前、术后2周及末次随访时行疼痛视觉模拟（VAS）评分评估腰腿痛的程度。末次随访时使用Macnab标准判定疗效。结果本组手术时间平均75 min,术中失血量平均150 ml,住院时间平均13 d,住院费用平均7430元,手术至开始行走时间平均11 d。随访时间5-53个月,平均18个月。术后2周及末次随访时VAS评分均低于术前（t=4.353、7.865,P〈0.05）,末次随访时VAS评分低于术后2周（t=6.597,P〈0.05）。末次随访时疗效：优20例,良8例,可5例,差1例,优良率82.35%。结论微创椎间盘切除术治疗老年腰椎间盘突出症有良好的效果。

Minimally Invasive Discectomy in Treatment of 34 Elderly Patients with Lubar Intervertebral Disc Protrusion

Objective To study the efficacy of minimally invasive discectomy in treatment of elderly patients with lubar intervertebral disc protrusion. Methods A total of 34 elderly patients with lubar intervertebral disc protrusion admitted during January 2010 and January 2014,who had had the indications of minimally invasive discectomy,underwent Quadrant channel of minimally invasive discectomy. The operation time,intraoperative blood loss volume,the time from surgery to walking,length of stay and hospitalization cost were recorded; the patients were followed up for 1 time at1 st,2nd,3rdand 6thmonth,and then the follow-up was performed every six months for one time. Degree of low back pain was evaluated by visual analogue scales（ VAS） before and two weeks after the operation and during the last follow-up.The curative effect was evaluated by Macnab standard in the last follow-up. Results The mean operation time was75 min; mean intraoperative blood loss volume was 150 ml; the mean length of stay was 13 d; the mean hospitalization cost was 7430 RMB; the mean time from surgery to walking was 11 d. The follow-up time was 5-53 months with the mean time of 18 months. VAS scores of postoperative two weeks and the last follow-up were significantly lower than that before the operation（ t = 4. 353,7. 865,P〈0. 05）. VAS score in the last follow-up was significantly lower than that of two weeks after the operation（ t = 6. 597,P〈0. 05）. The efficacy in the last follow-up showed that 20 cases were excellent,8 cases were good,5 cases were common,and 1 case was poor,and the excellence and good rate was 82. 35%. Conclusion Minimally invasive discectomy in treatment of elderly patients with lubar intervertebral disc protrusion may achieve better efficacy.