后路椎间盘镜手术治疗老年腰椎间盘突出症的临床疗效及患者预后的影响因素分析

Clinical efficacy of posterior microendoscopic discectomy for the treatment of lubar intervertebral disc protrusion and the risk factors of prognosis in elderly patients

目的:观察后路椎间盘镜手术治疗老年腰椎间盘突出症的临床疗效,并分析影响患者预后的危险因素。方法:回顾性分析2014年2月至2016年2月在我院行后路椎间盘镜手术的38例老年腰椎间盘突出症患者的临床资料,观察患者的临床治疗效果,并对影响患者预后的危险因素进行单因素及多因素Logistic回归分析。结果:38例患者均顺利完成手术,根据日本骨科协会(JOA)评分标准,优19例,良16例,可3例,优良率为92.11%,腰痛的视觉模拟评分(VAS)改善率为83.51%;多因素Logistic回归分析结果显示:年龄、病程、突出位置、糖尿病、冠心病、肾功能不全及慢性阻塞性肺病(COPD)是影响患者预后的独立危险因素(P<0.05),高密度脂蛋白胆固醇(HDL-C)是患者预后的保护因素(P<0.05)。结论:采用后路椎间盘镜手术治疗老年腰椎间盘突出症的疗效显著,可以有效改善患者生活质量;年龄、病程、突出位置、糖尿病、冠心病、肾功能不全及COPD是影响老年患者预后的危险因素,HDL-C是其保护因素。

Objective： To evaluate the clinical efficacy of posterior microendoscopic discectomy （MED） for the treatment of lubar intervertebral disc protrusion （LIDP） and analyzed the risk factors influencing the prognosis of elderly patients. Methods： Clinical data of 38 elderly patients with MED who underwent LIDP in our hospital from February 2014 to February 2016 were retrospective analyzed. The clinical efficacy was observed. The risk factors influencing the prognosis were analyzed by univariate analysis and multi-factor logistic regression analysis. Results： All surgeries were completed successful. According to the Japanese Orthopaedic Association （JOA） score criteria, the operation was excellent in 19 cases, good in 16 cases and fair in 3 cases, and the excellence rate was 96.15%. 83.51% patients had an improvement of the visual analogue scale （VAS） score of osphyalgia. Univariate analysis showed that age, duration of disease, diabetes mellitus, coronary heart disease, renal insufficiency and chronic obstructive pulmonary disease （COPD） were the risk factors influencing patients＇ prognosis （ P 〈0.05）. Multivariate logistic regression analysis showed that age, duration of disease, diabetes mellitus, coronary heart disease, renal insufficiency and COPD were independent risk factors influencing the prognosis of patients （ P 〈0.05）, and high density lipoprotein-cholesterol （HDL-C） was the protective factor （ P 〈0.05）. Conclusion： MED could achieve a significant effect on LIDP in elderly patients. It could improve the prognosis of patients and the life quality. Age, duration of disease, diabetes mellitus, coronary heart disease, renal insufficiency and COPD were independent risk factors, but HDL-C was a protective factor influencing the prognosis of elderly LIDP patients.