| 侧卧位局麻下经皮椎间孔镜治疗合并全身性疾病的高龄腰椎间盘突出症 |
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投稿时间：2018-06-19
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| 作者 | Author | 单位 | Address | E-Mail |
| 姜吉宏 |
JIANG Ji-hong |
浙江大学明州医院脊柱外科, 浙江 宁波 315100 |
Department of Spinal Surgery, Mingzhou Hospital of Zhejiang University, Ningbo 315100, Zhejiang, China |
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| 李纯志 |
LI Chun-zhi |
浙江大学明州医院脊柱外科, 浙江 宁波 315100 |
Department of Spinal Surgery, Mingzhou Hospital of Zhejiang University, Ningbo 315100, Zhejiang, China |
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| 赵昌明 |
ZHAO Chang-ming |
浙江大学明州医院脊柱外科, 浙江 宁波 315100 |
Department of Spinal Surgery, Mingzhou Hospital of Zhejiang University, Ningbo 315100, Zhejiang, China |
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| 徐荣明 |
XU Rong-ming |
浙江大学明州医院脊柱外科, 浙江 宁波 315100 |
Department of Spinal Surgery, Mingzhou Hospital of Zhejiang University, Ningbo 315100, Zhejiang, China |
xu_rj@21cn.com |
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| 期刊信息：《中国骨伤》2018年，第31卷，第11期，第1065-1068页 |
| DOI：10.3969/j.issn.1003-0034.2018.11.016 |
| 基金项目: |
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中文摘要:
目的：探讨侧卧位局麻下经皮椎间孔镜治疗合并全身疾病的高龄腰椎间盘突出症的临床疗效。
方法：回顾性分析2013年6月至2017年6月收治的腰椎间盘突出伴全身系统疾病高龄患者44例，其中男26例，女18例，年龄70~86（77.5±3.5）岁，病程3周~6个月。通过侧卧位局麻下侧后方入路经皮椎间孔镜手术治疗。术后采用直腿抬高度数变化及Nakai标准评定手术效果，并采用视觉模拟评分（VAS）及JOA评分系统评估患者术前及末次随访时症状改善情况。
结果：所有患者术中及术后无相关严重并发症发生，并存的内科疾患未加重，全部安全度过围手术期。44例患者均获得随访，时间6~30个月，平均20个月。术后直腿抬高角度较术前改善明显。末次随访时，按照Nakai标准评定：优42例，良2例。末次随访VAS评分明显下降，JOA评分明显升高（P<0.01）。
结论：采用患者容易耐受、呼吸循环影响小、便于观察处置的侧卧位局部麻醉实施经皮椎间孔镜微创技术治疗合并全身疾病的高龄腰椎间盘突出症方法安全可行，临床疗效确切。多学科协同合作围手术期控制好并存疾病对于此类患者早期康复至关重要。 |
| 【关键词】椎间盘移位 外科手术,微创性 内窥镜检查 老年人 |
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| Percutaneous transforaminal endoscopic discectomy via lateral position assisted with local anesthesia for lumbar disc herniation in elder with systemic diseases |
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ABSTRACT
Objective: To explore the clinical effect of percutaneous transforaminal endoscopic discectomy via lateral position assisted with local anesthesia for lumbar disc herniation in elder with systemic diseases.
Methods: The clinical data of 44 elder patients with lumbar disc herniation and systemic diseases treated from June 2013 to June 2017 were retrospectively analyzed. Including 26 males and 18 females, aged 70 to 86 years old with an average of (77.5±3.5) years, course of disease was 3 weeks to 6 months. Percutaneous transforaminal endoscopic discectomy via lateral position assisted with local anesthesia was performed in the patients. Postoperative straight leg-raising degree change and Nakai criteria were used to evaluate the operative effect. Visual analogue scale (VAS) and JOA scoring system were used to compare the symptom improvement between preoperative and postoperative.
Results: No serious complications occurred during and after the operation, and the coexisting medical diseases were not aggravated. All patients safely survived the perioperative period. All the 44 cases were followed up from 6 to 30 months with an average of 20 months. Postoperative straight leg raising angle was obviously improved. At final follow-up, according to Nakai standard, 41 cases got excellent results, 3 good. VAS scores were significantly decreased and JOA scores were significantly increased in final follow-up (P<0.01).
Conclusion: Percutaneous transforaminal endoscopic discectomy via lateral position assisted with local anesthesia is a safe, effective, less invasive technique for the treatment of lumbar disc herniation in elder with systemic diseases. Multidisciplinary collaboration and perioperative well controlled disease are essential for early rehabilitation of such patients. |
| KEY WORDS Intervertebral disk displacement Sugical procedures,minimally invasive Endoscope Aged |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 姜吉宏,李纯志,赵昌明,徐荣明.侧卧位局麻下经皮椎间孔镜治疗合并全身性疾病的高龄腰椎间盘突出症[J].中国骨伤,2018,31(11):1065~1068 |
| 英文格式: | JIANG Ji-hong,LI Chun-zhi,ZHAO Chang-ming,XU Rong-ming.Percutaneous transforaminal endoscopic discectomy via lateral position assisted with local anesthesia for lumbar disc herniation in elder with systemic diseases[J].zhongguo gu shang / China J Orthop Trauma ,2018,31(11):1065~1068 |
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