微创髓核摘除术治疗高龄腰椎间盘突出症的临床研究

目的:探讨微创髓核摘除术治疗高龄腰椎间盘突出症的临床疗效。方法:收集2007年3月~2012年3月本科室收治的老年腰椎间盘突出症患者40例(年龄65岁,排除腰椎不稳),随机分为实验组和对照组,每组20例,其中实验组患者行微创Quadrant通道下髓核摘除术,对照组患者行腰椎后路椎管减压椎间盘摘除植骨融合内固定术。比较两组手术时间、切口长度、出血量、手术效果、椎间隙平均高度丢失量及腰椎平均前凸角改变等指标的差异。结果:实验组患者的手术时间、切口长度、出血量及术后3天VAS疼痛目测评分均明显低于对照组(P0.01)。腰椎平均前凸角改变显著小于对照组(P0.05)。实验组和对照组术后6个月改良MacNab分级优良率均为90%(P0.05),实验组术后2年椎间隙高度平均丢失量与对照组无明显差异(P0.05)。结论:相对腰椎后路椎管减压椎间盘摘除植骨融合内固定术而言,单纯微创髓核摘除术治疗高龄腰椎间盘突出症时具有手术时间短、出血少、创伤小的优势。

Research on the Clinical Efficacy of Minimally Nucleus Pulposus Prolapse in the Elderly Patients with Lumbar disc Herniation

Objective： To investigate the clinical effect of minimally nucleus pulposus prolapse in the elderly patients with lumbar disc herniation. Methods： 40 elderly patients who were over 65 years old with Lumber Disc Herniation （LDH） hospitalized fi＇om March 2007 to March 2012（lumbar instability patients were excluded） were selected and randomly divided into the experimental group and con- trol group （20 cases in each group）. The experimental group was treated with the QUADRANT, and the control group was treated with whole vertebral plate rejected, the internal fixation was used for comparison. The VAS score three days after surgery, MacNab grading, operation time, blade length, blood loss, Vertebra gap height and the Average Cobb＇s Angle were compared. Results： The operation time and blade length of experimental group were shorter than those of the control group, so were the bleed loss and the VAS score（P〈0.05）. No significant difference of the excellent and good rate of improved MacNab grading was found between two groups（P〉0.05）. Two years after the operation, no significant difference of the height loss of intervertebral was observed between two groups （P〉0.05）. But the average change of Cobb＇s angle of the experimental group was less than that of the control group （P〈0.05）. Conclusion： Compared with the internal fixation fusion surgery, Minimally invasive surgery had the advantage of less bleeding, less damage and quick recovery after operation in the treatment of the elder patients with LDH.S