CT引导经皮脊柱内窥镜治疗老年腰椎间盘突出症

Percutaneous endscopic lumbar discectomy for the elderly lumbar disc herniation guided by CT

[目的]探讨CT引导经皮脊柱内窥镜治疗老年腰椎间盘突出症的方法与疗效,总结临床经验。[方法]自2010年6月~2012年9月,对246例老年腰椎间盘突出症患者,按照手术方式分为传统手术组114例、CT引导经皮脊柱内窥镜组132例。记录两组患者围手术期观察指标：手术时间、切口长度、术中出血量、术后应用镇痛药物例数、术后卧床时间和住院时间;术后随访采用Oswestry功能障碍指数（owestry disability index,ODI）对两组患者术前、术后1周和1、3、6、12个月的日常生活能力进行评定。[结果]在手术时间、切口长度、术中出血量、术后应用镇痛药物例数、术后卧床时间和住院时间比较上内窥镜组明显优于传统手术组,差异具有统计学意义（P〈0.01）。术后随访12~24个月,两组患者术前ODI指数比较差异无统计学意义（P〉0.05）,两组术后各期ODI指数均较术前有显著改善,但脊柱内窥镜组术后ODI指数改善明显优于传统手术组（P〈0.01）、术后恢复更快。[结论]CT引导下设计和实施穿刺具有精确、安全、个性化操作的优点,CT引导经皮脊柱内窥镜治疗老年腰椎间盘突出与传统开放性手术比较具有微创、精准、恢复快等优点,疗效满意,是治疗老年腰椎间盘突出症的理想方法。

[Objective] To investigate the rusults and summarize the clinical experience of percutaneous endscopic lumbar discectomy（ PELD） on intervertebral disc herniation in the elderly guided by CT. [Methods] From June 2010 to September2012,246 cases of lumbar intervertebral disc herniations in the elderly underwent different surgical procedures,114 cases were treated by conventional discectomy,132 cases were treated by percutaneous endscopic lumbar discectomy with CT guidance.The average skin incision,operation time,the average blood loss,the number of cases using analgesic drug,postoperative stay hospitallization time were compared. The Oswertry disability index（ ODI） of two groups at 1 week,1,3,6,12 month of the follow- up were also evaluated. [Results] The operation time,the average skin incision,the average blood loss,the number of cases using analgesic drug,postoperative stay hospitallization time of endscopic lumbar discectomy group were better than that of the conventional discectomy group（ P 〈 0. 01）. All the cases were followed up for 12 ~ 24 months,there was no significant different in preoperative ODI between the two groups,the postoperative ODI between two groups at 1 week,1,3,6,12 month showed statistically significant difference,the improvement of endscopic lumbar discectomy group was better than in the conventional discectomy group（ P 〈 0. 01）. [Conclusion] To design and complete the puncture with CT guidance is accurate,safe and individual. Percutaneous endscopic lumbar discectomy guided by CT has the advantage of less tissue trauma and quicker recovery than conventional discectomy. It is a kind of minimal invasive,precise surgical technique for elder patients with lumbar interverbral disc herniation.