MED选择性减压治疗老年椎间盘突出合并腰椎管狭窄症疗效观察

Efficacy of micro endoscopic discectomy selective decompression in the treatment of elderly lumbar disc herniation combined with lumbar spinal stenosis

目的观察显微内窥镜椎间盘切除(MED)选择性减压术式(简称"MED术式")治疗老年椎间盘突出合并腰椎管狭窄的疗效情况。方法 2010年1月至2012年1月应用MED术式,经椎板间隙入路选择性减压手术治疗老年椎间盘突出合并腰椎管狭窄患者51例,以数字表法随机分成观察组(25例)和对照组(26例)。对照组依次实施后路椎板全切除减压术,而观察组则行MED术式治疗。记录手术时间及术中出血量。术后3个月观察治疗效果。结果观察组优良率为92.00%(23/25),高于对照组的69.23%(18/26),其差异具有统计学意义(P<0.05),但观察组和对照组在优、良、可、差等项目中分别比较,差异均无统计学意义(均P>0.05)。观察组平均手术时间为(65.2±4.5)min,术中出血量(55.4±3.7)ml,显著低于对照组(86.3±2.4)min、(68.8±2.6)ml。差异均有统计学意义(均P<0.05)。结论 MED术式治疗老年椎间盘突出合并腰椎管狭窄可获得良好的近期临床效果,是一种安全有效的微创手术方法。

Objective To observe the efficacy of micro endoscopic discectomy selective decompression （MEDSD） in the treatment of elderly lumbar disc herniation combined with lumbar spinal stenosis. Methods From January 2010 to January 2012, 51 patients with elderly lumbar disc herniation combined with lumbar spinal stenosis were treated with MEDSD through interlaminar approach, and they were randomly divide in to observation group （25 cases） and control group （26 cases） using digital table method. Patients in the control group were treated with posterior translaminar resection and decompression, while patients in the observation group were treated with MEDSD. The operative time and blood loss were recorded. After 3 months, we observed the treatment effect. Results The excellent rate in the observation group was 92.00% （23/25）, significantly higher than 69.23% （18/26） in the control group. （P〈 0.05）. The two groups showed no statistically significant difference in the excellent, good, fair, poor rate each （all the P〉0.05）. The average operative time was （65.2 ± 4.5） rain, blood loss was （55.4±3.7） ml in the observatin group, significantly lower than those in the control group of（86.3±2.4） rain, （68.8±2.6） ml （all the P〈0.05）. Conclusion MEDSD can obtain satisfactory clinical efficacy in the treatment of elderly lumbar disc herniation combined with lumbar spinal stenosis,, with safe and effective minimally invasive advantages.