椎间孔镜髓核摘除术治疗老年单节段腰椎间盘突出症临床疗效分析

Analysis of the clinical effect of endoscopic lumbar discectomy in the treatment of senile single-segment lumbar disc herniation

目的探讨椎间孔镜髓核摘除术治疗老年单节段腰椎间盘突出症的临床效果。方法选择2014年3月至2017年3月于本院治疗的单节段腰椎间盘突出症老年患者88例,根据手术方式分为试验组(44例)和对照组(44例),试验组患者采用椎间孔镜髓核摘除术治疗,对照组患者采用椎板开窗髓核摘除术治疗,比较两组患者术中出血量、下地时间、住院天数和随访期内并发症发生率,以及术前、术后次日和术后1个月视觉模拟评分法(visual analogue scale,VAS)评分、Oswestry 功能障碍指数(Oswestry disability index,ODI)评分和末次随访时改良 Macnab 疗效评分。试验组患者根据椎间盘突出分型分为突出型、轻度脱垂游离型及重度脱垂游离型,比较不同分型患者术前、术后次日和术后1个月 VAS 评分、ODI 评分和末次随访时改良 Macnab 疗效评分。结果术后次日和术后1个月,两组患者 VAS 评分和 ODI 评分对比差异均无显著性(P>0.05),而试验组患者末次随访时改良 Macnab 疗效优良率高于对照组(P<0.05),试验组患者术中出血量显著少于对照组(P<0.05),下地时间和住院天数均显著短于对照组(P<0.05),并发症发生率显著低于对照组(P<0.05)。试验组重度脱垂游离型患者的改良 Macnab 疗效优良率显著低于突出型和轻度脱垂游离型患者(P<0.05),而三者间 ODI 评分和 VAS 评分对比差异均无显著性(P>0.05)。结论椎间孔镜髓核摘除术治疗老年单节段腰椎间盘突出症,在保证疗效的前提下可显著减少出血量、缩短住院天数、降低并发症发生率,但针对椎间盘重度脱垂游离型病变其治疗效果仍有待提高。

Objective To explore the clinical efficacy of endoscopic lumbar discectomy in the treatment of senile single-segment lumbar disc herniation(LDH).Method From March 2014 to March 2017,88 elderly patients with single-segment LDH in our hospital were selected,they were divided into experimental group(n=44)and control group(n=44)according to the operation method.Experimental group patients were treated with endoscopic lumbar discectomy,while control group patients were treated with either fenestration discectomy.Blood loss,active time,hospitalization time,rate of complications and the visual analogue scale(VAS)score,Oswestry disability index(ODI)score and modified Macnab score were compared between the two groups.Experimental group was divided into prominent type,mild migrated LDH type and highly migrated LDH type according to LDH classification.VAS scores,ODI scores and modified Macnab scores were compared among the three types.Result The next day and 1 month after operation,the VAS scores and ODI scores between the two groups were not statistically significant(P>0.05).The excellent rate of modified Macnab of experimental group was higher than control group at the last follow-up time(P<0.05).The blood loss of experimental group was significantly lower than control group(P<0.05),the active time and hospitalization time were significantly shorter than control group(P<0.05),the rate of complications was significantly lower than control group(P<0.05).Besides,the excellent rate of modified Macnab of highly migrated LDH type was lower than other two types(P<0.05).But there were no significant differences of ODI scores and VAS scores among the three types(P>0.05).Conclusion The endoscopic lumbar discectomy can significantly reduce the blood loss,shorten the hospitalization time and reduce the complications under the premise of curative effect.However,the curative effect of highly migrated LDH type need to be further improved.