椎间盘镜手术在治疗高龄椎间盘突出症患者中的应用价值

The minimally invasive surgery of lumbar disc herniation with micro- endoscope in old patients

目的探讨椎间盘镜手术在治疗高龄椎间盘突出症患者中的应用价值。方法2011年6月至2012年9月，对收治的45例高龄腰椎间盘突出症患者，采用椎间盘镜进行微创手术治疗。记录所有患者的手术时间、术中出血量及术后并发症。比较术前及术后的MRI影像，并参照Macnab标准评估术后功能恢复情况。结果所有患者均获随访，平均17．6个月（13—25个月）。手术时间平均为65min（42—110min）。术中出血量平均为72ml（40—200m1）。1例患者出现术中手术节段定位错误，1例出现术中脑脊液漏。所有患者术后第一天即开始下地活动，术后神经根压迫症状明显缓解。术后MRI显示所有患者手术节段椎间盘位置无髓核残留。术后1年参照Nakai标准评估疗效：优良率达到93％。结论椎间盘镜手术具有手术创伤小、出血少、术后恢复快的优点，应用于高龄椎间盘突出症患者能取得良好的疗效。

Objective To explore the clinical value of disectomy of lumbar disc herniation in old patients with micro - endoscope. Meth- otis From July 2011 to September 2012, forty - five old patients suffered from lumber disc herniation were treated with disectomy by micro - en- doscope. The surgical time, blood loss, complications and clinical results were documented and analyzed. The functional recovery were evaluated according to the Macnab scales. Results All the patients were followed up at an average of 17.6 months （ 13 - 25 months）. The average opera- tive time was 65 rain （ from 42 to 110 min）. The average blood loss was 72 ml （40 - 200 ml）. One patient was found wrong location of the surgi- cal site. One patient was found dural theca leakage. All patients got obvious improvement in neurological function after surgery. All patients were allowed to stand with full weight bearing from the first day after operation. There was no residual nuclear pulposus on the MRI one year after opera- tion. According to Nakai scales, rate of excellent and good condition in functional recovery was 93%. Conclusion The discetomy of lumbar disc herniation with micro - endoscope is of minimal invasive, less blood loss and fast recovery. It is very useful for the surgical treatment of lumbar disc herniation in the old patients.