经皮椎间孔镜治疗老年腰椎间盘突出症的近中期疗效

Preliminary outcomes of percutaneous transforaminal endoscopic lumbar discectomy treating elderly pa-tients with lumbar disc herniation

目的 系统评价经皮椎间孔镜治疗老年腰椎间盘突出症的近中期临床效果.方法 选择2010年11月至2011年11月于湖南省株洲中心医院治疗老年性腰椎间盘突出症120例患者.完全随机分为传统手术组和椎间孔镜组,每组60例.观察比较2组患者围手术期观察指标、围手术期手术切口、术后24、48、72、96 h视觉模拟评分（VAS）,并采用Oswestry功能障碍指数（ODI）对2组患者术前、术后1、6、12及24个月的日常生活能力进行评定.结果 椎间孔镜组在切口长度、手术时间、术中出血量、术后卧床时间和住院时间方面明显优于传统手术组[分别为（0.69±0.23） cm比（4.92±0.35） cm,（60±12） min比（71±18）min,（11.6 ±2.2）ml比（85.9±16.3）m1,（27±8）h比（94±19）h,（3.3±1.1）d比（8.3±2.1）d],差异均有统计学意义（P ＜0.05或P＜0.01）.椎间孔镜组在24、48、72、96 h VAS分别为（3.76±1.21）、（2.19±1.13）、（1.45±0.93）和（0.72 ±0.18）分,明显低于传统手术组（6.83±1.97）、（5.39±1.68）、（4.41±1.56）和（3.27±1.05）分,差异具有统计学意义（P＜0.05）.椎间孔镜组患者术后1、6个月时ODI明显优于传统手术组患者[分别为（12.1±4.7）分比（18.6±3.6）分,（5.4±2.3）分比（13.2±2.7）分]（P＜0.05）.结论 腰椎经皮椎间孔镜技术在手术切口、术中出血量、术后卧床和住院时间等方面具有微创优越性,对脊柱稳定结构破坏最小,患者术后恢复快,是治疗老年腰椎间盘突出症患者的一种新的有效的微创手术方式.

Objective To evaluate the preliminary outcomes of percutaneous transforaminal endoscopic lumbar discectomy treating elderly patients with lumbar disc herniation.Methods From November 2010 to November 2011,120 elderly patients with lumbar disc herniation were randomly divided into 2 groups：the traditional surgery group and percutaneous transforaminal endoscopic discectomy（PTED） groups.The index of operations and the preoperative and postoperative visual analogue scale（VAS） of two groups were compared.The oswestry disability index （ODI） of two groups at 1,6,12,24 month of the follow-up was also evaluated.Results The average skin incision,operation time,the average blood loss,the number of cases using analgesic drug,postoperative stay and hospitalization time in PTED group were all better than those in the traditional surgery group [（0.69 ± 0.23） cm vs （4.92 ±0.35）cm,（60 ± 12）min vs（71 ± 18）min,（11.6 ±2.2）ml vs （85.9 ± 16.3） ml,（27 ±8）h vs（94 ± 19） h,（3.3 ± 1.1） d vs （8.3 ± 2.1） d] （P 〈 0.05）.The improvement of VAS in PTED group at 24,48,72,96 h was （3.76 ± 1.21）,（2.19 ± 1.13）,（1.45 ± 0.93） scores and （0.72 ± 0.18） scores,significantly better than that in the traditional surgery group [（6.83 ± 1.97）,（5.39 ± 1.68）,（4.41 ± 1.56） scores and （3.27 ± 1.05） scores] （P 〈 0.05）.There was no significant difference in preoperative ODI between the two groups.The ODI of two groups at 1,6 month was statistically different in the two groups （P 〈 0.05）.But the improvement of PTED group was better than that of the traditional surgery group [（12.1 ± 4.7） scores vs （18.6 ± 3.6） scores,（5.4 ± 2.3） scores vs （13.2 ± 2.7） scores] （P 〈 0.05）.Conclusions Compared with conventional therapy,PTED has the advantages of smaller incision,less bleeding,less postoperative stay and hospitalization time,tissue trauma and quicker recovery.It is a safe and good minimally invasive surgical technique for elderly patients with lumbar disc herniation.