经皮椎间孔镜与后路椎间盘镜治疗老年单节段腰椎间盘突出症疗效比较

Comparison of the therapeutic effect of percutaneous transforaminal endoscopic discectomy and posterior discectomy on senile single segmental lumbar disc herniation

目的比较经皮椎间孔镜与后路椎间盘镜对老年单节段腰椎间盘突出症(lumbar disc herniation,LDH)的治疗效果。方法选择2014年1月至2015年1月本院收治的273例老年单节段LDH患者为研究对象,将其随机分为观察组(137例)和对照组(136例)。观察组患者采用经皮椎间孔镜下腰椎间盘髓核摘除术,对照组患者采用后路椎间盘镜下腰椎间盘切除术,观察并比较两种方法治疗老年单节段LDH的临床效果。结果术前两组患者视觉模拟评分法(visual analogue scale,VAS)评分比较无显著差异(P>0.05),术后两组患者VAS评分均明显低于术前(P<0.05),且术后15天观察组患者VAS评分显著低于对照组(P<0.05)。术后3个月,两组患者VAS评分比较无显著差异(P>0.05)。对照组患者手术时间显著短于观察组(P<0.05),术中透视次数显著少于观察组(P<0.05),术中出血量显著多于观察组(P<0.05),手术切口长度、术后卧床时间及住院天数均显著长于观察组(P<0.05)。两组患者术后Oswestry功能障碍指数(Oswestry dability index,ODI)评分均显著低于术前(P<0.05),但术前及术后组间ODI评分比较均无显著差异(P>0.05)。观察组患者术后并发症发生率显著低于对照组(P<0.05),术后复发率显著高于对照组(P<0.05)。结论经皮椎间孔镜与后路椎间盘镜治疗老年单节段LDH均具有较好的疗效,且经皮椎间孔镜造成的创伤更小,患者恢复更快,术后并发症发生率更低,但复发率较高,需严格掌握手术适应证。

Objective To compare the therapeutic effect of percutaneous transforaminal endoscopic discectomy on elderly patients with senile single segmental lumbar disc herniation(LDH).Method A total of 273 senile single segment LDH patients from January 2014 to January 2015 in our hospital were selected as study subjects,and they were randomly divided into observation group(n=137)and control group(n=136).Observation group patients were underwent percutaneous transforaminal endoscopic discectomy and control group patients were underwent posterior microendoscopic discectomy.Observed and compared the therapeutic effect of the two methods on elderly single segment LDH patients.Result There was no significant difference in visual analogue scale(VAS)scores between the two groups before operation(P>0.05).VAS scores in both groups after operation were significantly lower than those before operation(P<0.05),and 15 days after operation,VAS score of observation group was significantly lower than control group(P<0.05).3 months after operation,there was no significant difference in the VAS scores between the two groups(P>0.05).The operation time of control group was significantly shorter than that of observation group(P<0.05),the frequency of intraoperative fluoroscopy was significantly less than that of observation group(P<0.05),and the amount of bleeding during the operation was significantly more than that of observation group(P<0.05).The length of the incision,the bed time after operation and hospital stay were significantly longer than those in observation group(P<0.05).The Oswestry dability index(ODI)scores of the two groups were significantly lower than those before operation(P<0.05),but there was no significant difference between the two groups in ODI scores before and after operation(P>0.05).The incidence of postoperative complications in observation group was significantly lower than control group(P<0.05),but the recurrence rate was significantly higher than control group(P<0.05).Conclusion Percutaneous transforaminal endoscopic discectomy and posterior discectomy for the treatment of senile single segmental LDH in elderly patients have good curative effect,percutaneous transforaminal endoscopic discectomy hasless trauma,faster recovery and lower postoperative complication rate,but the rate of recurrence is relatively higher,so we need to strictly grasp the indications for surgery.