经皮腰椎间盘摘除术治疗老年腰椎间盘突出症患者48例

Percutaneous diskectomy for the treatment of lumbar intervertebral disc herniation in aged patients:a report of 48 cases

目的探讨经皮腰椎间盘摘除术(PLD)治疗70岁以上腰椎间盘突出症适应证的选择,操作技巧及疗效。方法2004年8月至2008年7月采用PLD治疗70～79岁腰椎间盘突出症患者48例,共有56个椎间盘突出,均为包容性椎间盘突出。随机选取52例70～81岁,症状体征及影像学分型与PLD组相近似的腰椎间盘突出症患者行保守治疗,设为对照组。采用MacNab标准分别在治疗后6和12个月进行随访。结果56个椎间盘中54个穿刺治疗成功,成功率约96.4%。全部患者得到随访。6个月PLD组显效率29.1%,有效率52.1%;对照组显效率19.2%,有效率36.5%。12个月PLD组显效率25.0%,有效率47.9%;对照组显效率17.3%,有效率32.7%。PLD组的疗效优于对照组(χ2=7.45,P<0.01;χ2=5.57,P<0.05)。结论PLD治疗70岁以上腰椎间盘突出症对近期加重的症状疗效较好,能有效缓解临床症状;对于椎间盘钙化者,可直接用环锯"开窗"治疗。

Objective To discuss the indications, technical skills and the therapeutic effects of percutaneous lumbar diskectomy （PLD） for the treatment of lumbar intervertebral disc herniation in patients over 70 years. Methods From August 2004 to July 2008, PLD was performed in 48 patients （aged 70-79） with lumbar intervertebral disc herniation. A total of 58 lumbar intervertebral disc herniations were detected, all of which were encapsulated intezvertebral disc herniation. Fifty-two patients, who showed similar symptoms, signs and same imaging manifestations and were 70-81 years old, were randomly selected as control group to receive conservative treatment. Results Of 56 lumbar intervertebral disc herniations, 54 were successfully punctured with a successful rate of 96.4%. All patients were followed up. The excellent rate and the effective rate at 6 months were 29.1% and 52.1% respectively for PLD group, while that were 19.2% and 36.5% respectively for control group. The excellent rate and the effective rate at 12 months were 25.0% and 47.9% respectively for PLD group, while that were 17.3% and 32.7% respectively for control group. At both 6 and 12 months after the treatment, the therapeutic： effects of PLD group were significantly better than that of control group, the difference were statistically significant （X2 = 7.45, P 〈 0.01 and X2 = 5.57, P 〈 0.05）. CoBelusion For the treatment of lumbar intervertebral disc herniation in patients over 70 years, PLD is better than conservative treatment as PLD has obvious short-term effect in relieving clinical symptoms. For lumbar intervertebral disc herniation with calcified disc, direct ring-sawing ＂windowing＂ technique is recommended.