经皮椎间孔镜下椎间盘切除术治疗中老年腰椎间盘突出症

Percutaneous endoscopic lumbar discectomy for treatment of lumbar disc herniation

目的评价经皮椎间孔镜下腰椎间盘切除术（PELD）治疗经保守治疗无效的中老年腰椎间盘突出症的临床效果。方法 14例经保守治疗无效的中老年腰椎间盘突出症患者,经椎间盘造影证实14个椎间盘后方纤维环均撕裂,行PELD治疗。比较术前、术后疼痛视觉模拟评分（VAS）和术前、末次随访时Oswestry功能障碍指数（ODI）,按改良Macnab标准评价临床疗效。结果手术时间60120（96±18.1）min,术中出血量1030（16±8.6）m L。住院时间39（4.6±1.3）d。14例均获随访,时间212（6.9±4.3）个月。术中未发生脑脊液漏、脊髓神经损伤。VAS术前为610（7.9±1.8）分,术后为03（1.8±1.2）分,差异有统计学意义（P〈0.01）。ODI术前为52.0%85.1%（78.1±17.3）%,末次随访时为10.8%24.1%（16.2±5.2）%,差异有统计学意义（P〈0.01）。根据改良Macnab标准：优7例,良6例,可1例。结论 PELD治疗经保守治疗无效的中老年腰椎间盘突出症患者具有创伤小、恢复快、住院时间短等特点,疗效较好。

Objective To evaluate the clinical outcomes of percutaneous endoscopic lumbar discectomy（ PELD）for middle-aged and elderly patient with lumbar disc herniation failing to conservative treatment. Methods The 14middle-aged and elderly patients with lumbar disc herniation failing to conservative treatment were treated. Discography showed positive response,fluoroscopy confirmed annulus fibrosus tears of posterior intervertebral disc in 14 discs.PELD was performed. Visual analogue scale（ VAS） and Oswestry disability index（ ODI） were evaluated before operation and after operation. The clinical outcome was determined by modified Macnab criteria at the final follow-up. Results The operation time was 60-120（ 96 ± 18. 1） minutes,mean blood loss was 10-30（ 16 ± 8. 6） ml and length of hospital stay was 3-9（ 4. 6 ± 1. 3） days. 14 cases were followed up for 2-12（ 6. 9 ± 4. 3） months. There was no cerebrospinal fluid leakage and nerve damage. VAS score before operation,after operation were 6-10（ 7. 9 ± 1. 8） and 0-3（ 1. 8 ± 1. 2） scores respectively,indicating there were significant differences compared with preoperative score（ P〈0. 01）. ODI before operation,at the final follow-up were 52. 0%-85. 1%（ 78. 1% ± 17. 3%） and 10. 8%-24. 1%（ 16. 2% ± 5. 2%） respectively,indicating there were significant differences compared with preoperative scores（ P〈0. 01）. According to the modified Macnab criteria,4 cases were graded as excellent,6 as good,4 as fair. Conclusion PELD is effective in treating middle-aged and elderly patients with lumbar disc herniation failing to conservative treatment. It has the advantages of less trauma,quick recovery and less length of hospital stay.