椎间孔镜与椎板减压治疗老年双节段椎管狭窄的疗效分析

The Efficacy of Percutaneous Transforaminal Endoscopic Discectomy and Laminar Decompression in the Treatment of Double-Segment Spinal Stenosis in Elderly Patients

目的分析应用椎间孔镜与椎板减压术治疗老年双节段椎管狭窄的临床疗效.方法以该院2016年7月—2018年7月期间收治的符合手术指征的老年双节段腰椎管狭窄患者72例为研究对象,按照患者住院行手术治疗的时间先后顺序随机分到对照组和观察组,每组各包含36例患者.对照组行后入路切开椎管减压椎弓根钉内固定术,观察组行双节段椎间孔镜手术治疗.比较两组临床治疗有效率、手术耗时、术中失血量、住院时间、术后24 hVAS评分以及术后半年ODI评分.结果对照组有效33例,无效3例,观察组有效31例,无效5例,两组比较,差异无统计学意义(x^2=0.14,P>0.05);住院时间对照组(16.72±3.47)d,观察组(10.33±3.10)d,观察组住院时间短,差异有统计学意义(t=8.24,P<0.05);术后24 hVAS评分对照组(5.50±1.08)分,观察组(2.22±1.35)分,观察组评分低,差异有统计学意义(t=11.34,P<0.05);术后6个月ODI评分对照组(15.06±10.26)分,观察组(14.69±12.20)分,差异无统计学意义(t=0.139,P>0.05);术中失血量对照组(398.61±146.13)mL,观察组(17.78±2.96)mL,观察组失血量少,经Mann-Whitney秩和检验,差异有统计学意义(P<0.05);手术耗时对照组(153.75±47.84)min,观察组(136.53±24.61)min,经Mann-Whitney秩和检验,差异无统计学意义(P>0.05).结论应用椎间孔镜治疗老年双节段椎管狭窄可以达到与传统开放手术同样的疗效,且创伤小,术后恢复快,临床疗效显著.

Objective To analyze the clinical efficacy of percutaneous transforaminal endoscopic discectomy (PTED) and laminar decompression in the treatment of double-segment spinal stenosis in elderly patients. Methods A total of 72 elderly patients with double-segment lumbar spinal stenosis and surgical indications in our hospital were selected from July 2016 to July 2018. In accordance with the sequence of surgery, all the patients were divided into the control group and the observation group, with 36 patients in each group. The control group underwent posterior approach and spinal canal decompression and pedicle screw fixation. The observation group underwent double-segment PTED. The clinical treatment efficiency, operation time, blood loss, hospitalization time, postoperative 24h VAS score and postoperative ODI score in 6 months were compared between the two groups. Results The control group was effective in 33 cases and ineffective in 3 cases. The observation group was effective in 31 cases and ineffective in 5 cases. There was no significant difference between the two groups (χ^2=0.14, P>0.05). The hospitalization time control group (16.72±3.47)d In the observation group (10.33±3.10)d, the length of hospital stay in the observation group was short, and the difference was statistically significant (t=8.24, P<0.05). The VAS score was control group (5.50±1.08) points and the observation group (2.22±1.35) points, the observation group score was low, the difference was statistically significant (t=11.34, P<0.05);the ODI score of the control group (15.06±10.26) points and the observation group (14.69±12.20) points after the operation for six months, the difference was not statistical Learning significance (t=0.139, P>0.05);intraoperative blood loss control group (398.61±146.13) mL, observation group (17.78±2.96) mL, observation group had less blood loss, Mann-Whitney rank sum test, the difference was Statistical significance (P<0.05);operation time control group (153.75±47.84) min, observation group (136.53±24.61) min, Mann-Whitney rank sum test, the difference was not statistically significant (P>0.05). Conclusion The application of PTED in the treatment of double-segment spinal stenosis in the elderly can achieve the same curative effect as traditional open surgery, with less trauma, rapid postoperative recovery and significant clinical effect.