侧路椎间孔镜治疗老年腰椎间盘突出症伴椎间孔狭窄疗效观察

Treatment of elderly lumbar disc herniation with intervertebral foramen stenosis by lateral intervertebral foramen

目的探讨侧路椎间孔镜治疗老年腰椎间盘突出症伴椎间孔狭窄的临床疗效。方法选取2017年6月—2019年1月收治的腰椎间盘突出症老年患者61例,均采用侧路椎间孔镜手术治疗,采用视觉模拟评分法(VAS)和日本骨科协会下腰痛疾患疗效评定法(JOA)评定治疗效果。结果平均手术时间121 min,术后卧床1 d,未出现永久性神经根损伤、硬脊膜撕裂等并发症。术后随访3个月~5个月,平均时间为4个月,手术前腿痛VAS为(7.0±1.3)分,术后即刻为(2.1±1.1)分,术后3个月(2.1±0.3)分,末次随访(1.9±0.7)分,手术前后差异显著(P<0.01):手术前JOA为(7.3±2.3)分,术后1 d(17.1±3.1)分,术后3个月(20.3±3.1)分,末次随访(21.1±3.2)分,手术前后差异显著(P<0.05)。结论采用侧路椎间孔镜治疗老年腰椎间盘突出症伴椎间孔狭窄是安全、有效的脊柱微创手术方法。

Objective To investigate the clinical efficacy and surgical technique of lateral intervertebral foramen in the treatment of lumbar disc herniation with intervertebral foramen stenosis.Methods Sixty-one patients with lumbar disc herniation who underwent lumbar disc herniation from June 2017 to January 2019 were treated with lateral intervertebral foramen.The efficacy evaluation was performed using visual analog scale(VAS)and the Japanese Orthopaedic Association Low Back Pain Evaluation(JOA).Results The average operation time was 121 minutes.After the operation for 1 day,there were no complications such as permanent nerve root injury and dural tear.The patients were followed up for 3 to 5 months,the average time was 4 months.The VAS of the leg pain before surgery was(7.0±1.3)points.The immediate postoperative condition was(2.1±1.1)points.The postoperative 3 months was(2.1±0.3)points.The last follow-up was(1.9±0.7)points,significant difference before and after surgery(P<0.01).JOAbefore operation was(7.3±2.3)points,(17.1±3.1)days after operation,(20.3±3.1)at 3 months after operation,and(21.1±3.2)at the last follow-up,the difference was significant before and after surgery(P<0.05).Conclusion The use of lateral intervertebral foramen for the treatment of elderly lumbar disc herniation with intervertebral foramen stenosis is a safe and effective minimally invasive procedure for the spine.