经椎间孔入路与椎板间入路脊柱内镜髓核摘除术治疗老年腰椎间盘突出症的临床观察

Clinical Observation of Percutaneous Endoscopic Transforaminal Discectomy and Percutaneous Endoscopic Interlaminar Discectomy in the Treatment of Elderly Lumbar Disc Herniation

目的探究经椎间孔入路脊柱内镜髓核摘除术(PETD)与经椎板间入路脊柱内镜髓核摘除术(PEID)治疗老年腰椎间盘突出症的效果.方法选择我院2018年8月—2021年8月收治的70例老年腰椎间盘突出症患者,采用随机数字表法分为两组,每组35例.A组行PETD,B组行PEID.对比两组的围术期指标、脊柱稳定性、疼痛视觉模拟(VAS)评分、日本骨科协会评估治疗分数(JOA)评分及并发症发生率.结果A组的手术时间长于B组,透视次数多于B组,组间差异有统计学意义(P<0.05);两组术中出血量及住院时间比较,组间差异无统计学意义(P>0.05).术后,A组的腰椎曲度、腰椎前凸角度、椎间隙高度分别为(1.98±0.34)cm、(43.48±1.89)°、(12.91±1.86)mm,均大于B组的(1.80±0.24)cm、(41.03±1.82)°、(12.04±1.73)mm,组间差异有统计学意义(P<0.05).术后,两组的VAS、JOA评分比较,组间差异无统计学意义(P>0.05).两组的并发症发生率比较,差异无统计学意义(P>0.05).结论对老年腰椎间盘突出症患者而言,PETD、PEID均可获得理想疗效,但PETD术后患者的脊柱稳定性更好,利于促进其术后脊柱功能恢复,值得临床推广使用.

Objective To investigate the effect of percutaneous endoscopic transforaminal discectomy(PETD)and percutaneous endoscopic interlaminar discectomy(PEID)in the treatment of elderly patients with lumbar disc herniation.Methods 70 elderly patients with lumbar disc herniation admitted to our hospital from August 2018 to August 2021 were selected and were divided into two groups by random number table method,with 35 cases in each group.Group A was treated with PETD,Group B was treated with PEID.The perioperative indexes,spinal stability,pain visual analogue scale(VAS)score,Japanese Orthopaedic Association(JOA)score and complication rate were compared between the two groups.Results The operation time of Group A was longer than that of Group B,and the number of fluoroscopy was more than that of Group B,and the differences between the groups were statistically significant(P<0.05);there were no significant differences in intraoperative blood loss and hospital stay between the two groups(P>0.05).After surgery,the lumbar curvature,lumbar lordosis angle and intervertebral height in Group A were(1.98±0.34)cm,(43.48±1.89)°and(12.91±1.86)mm,respectively,which were all greater than(1.80±0.24)cm,(41.03±1.82)°and(12.04±1.73)mm in Group B,the differences between the groups were statistically significant(P<0.05).After surgery,there were no significant differences in the VAS and JOA scores between the two groups(P>0.05).There were no significant differences in the incidence of complications between the two groups(P>0.05).Conclusion For elderly patients with lumbar disc herniation,both PETD and PEID can achieve ideal efficacy,but the spinal stability of patients after PETD is better,which can promote the recovery of spinal function after surgery,and is worthy of clinical promotion.