椎间孔镜技术在老年腰椎间盘突出并侧隐窝狭窄中的应用

Application of transforaminal endoscopic technology for elderly lumbar disc herniation combined with lateral recess stenosis

目的:探讨经皮椎间孔镜技术在老年腰椎间盘突出并侧隐窝狭窄的临床效果。方法:选取120例老年腰椎间盘突出并侧隐窝狭窄患者作为研究对象,按照随机数字表法将患者分为研究组和对照组,每组60例。研究组局部麻醉下行椎间孔镜腰椎间盘切除术,对照组全身麻醉下行次全切开椎板减压+内固定融合手术。分别在术前、术后3个月、术后6个月评价患者腰、腿视觉模拟评分(visual analogue scale,VAS);术后6个月,使用腰椎Macnab评定标准对腰椎功能进行评分,比较腰椎Macnab评定优良率、手术时间、切口长度、术中出血量、术后住院时间、手术前后腰、腿VAS的差异。结果:治疗后6个月,研究组腰椎Macnab评定优良率为93.3%,对照组优良率为75.0%,研究组腰椎Macnab评定优良率显著高于对照组(P<0.05);研究组手术时间比较对照组长,差异具有统计学意义(P<0.05);与对照组比较,研究组切口长度和术后住院时间短,术中出血量少,差异具有统计学意义(P<0.05)。术前和术后6个月,两组腰部、腿部VAS比较差异无统计学意义(P>0.05);术后3个月,研究组腰部、腿部VAS均比对照组低,差异具有统计学意义(P<0.05)。结论:椎间孔镜技术治疗老年腰椎间盘突出并侧隐窝狭窄效果好,患者出血少,术后恢复快,值得推广使用。

Objective： To investigate the clinical effect of transforaminal endoscopic technology for elderly lumbar disc herniation combined with lateral recess stenosis patients. Methods： One hundred and twenty cases of elder patients with lumbar disc herniation with lateral recess stenosis in our hospital were randomly divided into a research group and a control group, 60 cases in each group. The research group were treated with percutaneous transforaminal technique discectomy, while the control group were treated with subtotal laminectomy incision and laminectomy incision. Lumbar function, visual analogue scale （VAS） of waist and leg of the two groups were testedbefore surgery and 3, 6 months after surgery, qhe lumbar function and its excellence rate evaluated by Macnab, operation time, incision length, blood loss, hospital stay time, and VAS of two groups were compared 6 months after surgery. Results： The Macnab evaluations excellent rate of the research group was signigicantly higher than that of the control group （P〈0.05）. The operation time, incision length, hospital stay time of the research group were significantly shorter than those of the control group （P〈0.05）. The blood loss of the research group was significantly less than that of the control group （P〈0.05）. There was no significant difference in VAS of waist and leg between two groups 6 months before and after surgery （P〉0.05）. VAS of waist and leg of research groups was significantly lower than control group （P〈0.05） 3 months after surgery. Conclusion： Transforaminal endoscopic technology has exactly effect on elderly lumbar disc herniation combined with lateral recess stenosis. Patients lose less blood and recovery is fast after surgery. It is worthy of widely used.