经皮椎间孔镜与开放减压手术治疗老年腰椎椎管狭窄症疗效对比

Outcomes of percutaneous transforaminal endoscopic discectomy and posterior lumbar interbody fusion for elder patients with lumbar spinal stenosis syndrome

目的评价经皮椎间孔镜下髓核摘除术(percutaneous transforaminal endoscopic discectomy,PTED)和传统后路椎体间融合术(posterior interbody fusion,PLIF)治疗老年性腰椎椎管狭窄症的临床疗效。方法回顾分析76例获完整随访的老年性腰椎椎管狭窄症患者的治疗情况。根据手术方法患者分为2组,A组41例行传统开放减压、PLIF,B组35例行PTED。记录2组患者围手术期观察指标、手术切口视觉模拟量表(vicual aneligue scale,VAS)评分、Oswestry功能障碍指数(Oswestry disability index,ODI)评价患者日常生活能力。结果与A组相比,B组手术时间、卧床时间、X线照射时间、出血量等指标显著降低(P<0.01)。随访结果显示2组患者术后24个月较术后1个月ODI明显改善,B组改善优于A组(P<0.05)。结论 PTED在术中切口、出血量、术后恢复等方面具有优越性,是一种有效的治疗腰椎椎管狭窄的术式。

Objective To compare the clinical outcomes of lumbar percutaneous transforaminal endoscopic discectomy （PTED） and traditional open decompression and posterior lumbar interbody fusion （PLIF） for elder patients with lumbar spi- nal stenosis syndrome. Methods From January 2009 to December 2011, 76 patients with lumbar spinal stenosis treated by PTED or PLIF and followed up for over 24 months were analyzed retrospectively. In Group A, 41 patients were treated with traditional open decompression PL1F, while 35 cases underwent PTED in Group B. The operative time, X-ray exposure time, bed time, postoperative ambulation, operative incision visual analogue scale （VAS） and blood loss were measured for both groups. Oswestry disability index （ODI） was evaluated at 1 and 24 months after treatment for detection on daily living activity. Results Compared with Group A, Group B had shorter operation time, X-ray exposure time, bed time （P 〈 0.01 ）. The average blood loss, analgesic drug usage cases of Group B were better than those of Group A （P 〈0.05）. The improvement of incision VAS of Group B was better than that of Group A （ P 〈 0.05 ）. The ODI at postoperative 1 and 94 month were better than that before operation for both groups, but the Group B had more improvement （ P 〈 0.05）. Conclusion PTED has advantages in incision, blood loss and postoperative recovery. It is an effective and safe procedure for the treatment for lumbar canal stenosis.