侧卧位与俯卧位椎间盘切除术治疗老年腰椎间盘突出症的对比研究

【目的】前瞻性对比研究侧卧位与俯卧位椎间盘切除术治疗老年腰椎间盘突出症的临床效果差别。【方法】对47例65岁以上老年腰椎间盘突出症患者行单节段小切口开窗椎间盘切除手术，23例行俯卧位手术（俯卧组），24例无法耐受俯卧位者行侧卧位手术（侧卧组）。比较两组手术时间、术中出血量、手术疗效的差异，术前及术后3个月、6个月、12个月、24个月、48个月进行VAS、ODI评分，末次随访按改良Macnab标准评价疗效。【结果]45例获得术后4年随访。侧卧组比俯卧组术中出血量少（P〈0．01），术后各时间点两组VAs及0DI均无统计学差异。术后4年两组优良率无统计学差异（91．4％VS91．0％，P〉0．05）。【结论】对于不能耐受俯卧体位的老年患者，侧卧位椎间盘切除术仍能取得满意的中期疗效。

Comparative Study of Lumbar Discectomy in Lateral and/or Prone Position for Elder Patients with Lumbar Disc Herniation

Objective]To prospectively compare the clinical results of lumbar discectomy in lateral posi‐tion and in prone position for elder patients with Lumbar disc herniation .Methods]Forty‐seven elder patients ( ≥ 65 years old) with lumbar disc herniation undergone single segment small incision discectomy were fol‐lowed up for 4 years .Twenty‐three patients underwent the operation in prone position (prone position group) , the other 23 patients who could not tolerate the prone position recieved the surgery in lateral position (lateral position group) .The operation time ,the amount of blood loss and the difference of curative effect between the two groups were compared .VAS and ODI scores were evaluated in 3 months ,6 months ,12 months ,24 months and 48 months before and after the operation .The curative effect of the last follow‐up was verified ac‐cording to the improved Macnab standard .Results]Forty‐five cases were followed up for 4 years after opera‐tion .The amount of bleeding during operation of the lateral group was less than that of the prone group ( P <0 .01) .There were no significant differences in VAS and ODI between the two groups at each time point after operation .There existed no statistical difference of the excellent rate of the two groups in 4 years after the sur‐gery (91 .4% vs 91% ,P > 0 .05) .Conclusion]For elderly patients who cannot tolerate the prone position ,the mid‐term curative effect of discectomy in lateral position is so far satisfactory .