CT引导经皮椎间孔镜治疗老年腰椎间盘突出症的疗效观察

TREATMENT OF SENILE LUMBAR INTERVERTEBRAL DISC HERNIATION USING CT GUIDED PERCUTANEOUS TRANSFORAMINAL ENDOSCOPY

目的:探讨CT引导下经皮椎间孔镜治疗老年性腰椎间盘突出症的临床疗效观察。方法:60例老年性腰椎间盘突出症患者,分为两组(n=30):对照组使用靶点射频联合胶原酶化学溶解术,治疗组使用TESSYS经皮椎间孔镜技术进行治疗。于术前、术后1天、术后3个月和术后6个月分别采用疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(oswestry disability index,ODI)和改良Macnab标准进行疗效观察。结果:两组患者在治疗后疼痛均得到明显改善,对照组VAS从术前6.57±0.55 cm下降到术后第一天的3.48±0.56 cm(P<0.01),ODI(%)值从术前72.73±2.59分下降到术后第1天的29.55±2.32(P<0.01);治疗组VAS从术前6.44±0.55 cm下降到术后第1天的2.16±0.64 cm(P<0.01),ODI(%)值从术前69.94±2.57分下降到术后第1天的19.18±1.52(P<0.01);治疗组术后3个月和术后6个月VAS和ODI(%)值均显著低于对照组(P<0.05);对照组优良率达到73.3%;治疗组优良率达到90%。结论:CT引导下的经皮椎间孔镜治疗老年性腰椎间盘突出症疗效明显优于靶点射频联合胶原酶化学溶解术。

Objective: To assess the clinical therapeutic efficacy of CT guided percutaneous endoscopic lumbar discectomy in the treatment of senile lumbar intervertebral disc herniation. Method: A total of 60 patients suffering from senile lumbar intervertebral disc herniation were divided into two groups (n=30): Patients in control group were treated with target radiofrequency combined with collagenase chemonucleolysis; Patients in therapy group were treated with TESSYS percutaneous endoscopic lumbar discectomy. The curative effect was assessed from visual analogue scale (VAS), Oswestry disability index (ODI) and modified Macnab standard before the operation, 1 day, 3 months and 6 months after the operation, respectively. Results: VAS scores of both groups were significantly decreased after therapy, compared with these before the operation. The VAS score in control group declined from 6.57±0.55 cm before operation to 3.48±0.56 cm on the 1st day after the operation (P < 0.01). The ODI (%) value dropped from 72.73±2.59 before operation to 29.55±2.32 on the l st day after operation (P < 0.01).The VAS score of the therapy group dropped from 6.44±0.55 cm before operation to 2.16±0.64 cm on the first day after operation (P < 0.01), and the ODI (%) value dropped from 69.94±2.57 before operation to 19.18±1.52 on the l st day after operation (P < 0.01). Both the VAS score and ODI (%) value in the therapy group 3 months and 6 months after operation were significantly lower than those of control group (P < 0.05). The excellent rate of the control group was 73.3% and that of the therapy group was 90.0%. Conclusion: The therapeutic efficacy of CT guided percutaneous endoscopic lumbar discectomy of senile lumbar intervertebral disc herniation is obviously better than that of the target radiofrequency combined with collagenase chemonucleolysis.