不同体位下PELD治疗老年患者腰椎间盘突出症的效果对比

Outcomes of Percutaneous endoscopic lumber discectomy for elder patients with symptomatic lumbar disc herniation: prone position versus lateral position

目的探究不同体位下应用椎间孔镜治疗有症状的老年腰间盘突出症患者的临床效果对比。方法前瞻性分析2015年8月~2016年10月本科室收治的54例有症状腰椎间盘突出症老年患者接受PTED手术。患者手术前后的腰痛情况和腰椎功能采用疼痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)评估;术中进行动脉血进行血气分析。结果两组患者术后2个月VAS疼痛评分、ODI评分较同组术前均得到有效缓解(P=0.034);在手术时间、术后功能恢复方面差异无统计学意义(P=0.77)。术中动脉血气分析可见两组间PaO_2、PaCO_2对比差异均有统计学意义(分别P=0.031,P=0.027)。而侧卧位组,患者满意度、再次接受手术意愿及推荐其他患者接受相同手术数量均高于俯卧位组。结论对于接受PTED的老年患者而言,侧卧位相较于俯卧位手术效果均确切,但侧卧位对于老年患者呼吸、循环系统影响更小。

Objective To observe the clinical outcome of percutaneous endoscopic lumbar discectomy(PELD) for elder patients with symptomatic lumbar disc herniation(LDH) under different operative positions. Methods A total 54 LDH patients included in this prospective research from 2015 to 2016. The efficacy of the surgery was assessed by visual analogue scle(VAS) score for low back pain, and the Oswestry disability index(ODI) for functional recovery. Analysis of arterial blood gas were conducted in intra-operation. Times and dosage of vasopressor used during intraoperative period were recorded to assess patients' cardio-pulmonary function. Results Operative time and postoperative recovery of two groups were found no significant difference at pre-/post-operation(P=0.77). VAS score and ODI of 2 groups are improved significantly two months after the surgery(P=0.034). Whereas, intra-operative PaO_2 and PaCO_2 in lateral position group were significantly better than that in prone position group(P=0.031, P=0.027, respectively). Besides, lateral position group also showed higher satisfaction. Conclusion PELD is an effective treatment for symptomatic LDH, no matter which operative position is to be used. Lateral position seems to be safer to the elder patients because of its lower influence on cardio-pulmonary function.