经椎间孔入路与椎板间入路脊柱内镜下治疗老年椎间盘突出症疗效及对VAS、JOA评分的影响

Effects of Transformational Percutaneous Endoscopic Lumbar Discectomy and Interlaminar Percutaneous Endoscopic Lumbar Discectomy on Lumbar Disc Herniation in the Elderly and Their Effect on VAS and JOA Scores

目的分析经椎间孔入路与椎板间入路脊柱内镜下治疗老年腰5骶1(L5S1)椎间盘突出症(LDH)疗效及对疼痛和腰部功能的影响。方法选取2016年1月-2018年12月拟接受经皮内镜下手术治疗的老年L5S1 LDH患者60例,按手术入路方式分为椎间孔组与椎板间组,每组30例。椎间孔组采用椎间孔入路,椎板间组采用椎板间入路。比较2组治疗后临床疗效,围术期指标、疼痛程度、腰部功能以及术后并发症情况。结果治疗后,2组治疗优良率比较差异无统计学意义(P>0.05);与椎间孔组比较,椎板间组手术时间更短,术中透视次数更少(P<0.05)。治疗后1 d、1个月,2组视觉模拟评分法(VAS)评分较治疗前明显降低,JOA评分明显升高(P<0.05)。2组腰部功能ODI评分治疗后1 d、1个月较治疗前降低(P<0.05)。2组并发症发生率比较差异无统计学意义(P>0.05)。结论经椎间孔入路与椎板间入路脊柱内镜下治疗老年L5S1 LDH均取得满意疗效,两种入路方式均能明显改善患者围术期指标,缓解患者疼痛,提高腰部功能,椎板间入路在手术时间与术中透视时间改善方面较椎间孔入路更具优势。

Objective To analyze the effects of transformational percutaneous endoscopic lumbar discectomy(TF-PELD)and interlaminar percutaneous endoscopic lumbar discectomy(IL-PELD)on the elderly with lumbar disc herniation(LDH)of lumbar vertebrae 5 sacral column 1(L 5S 1)and their effects on pain and lumbar function.Methods Sixty elderly patients with L 5S 1 LDH who underwent percutaneous endoscopic surgery from January 2016 to December 2018 were selected and divided into TF-PELD group(n=30)and IL-PELD group(n=30)according to different surgical methods.TF-PELD group received TF-PELD,while IL-PELD group received IL-PELD.The clinical efficacy after treatment,perioperative indicators,pain degree,lumbar function and postoperative complications were compared between the two groups.Results After treatment,there was no significant difference in the excellent and good rate of treatment between the two groups(P>0.05).Compared with TF-PELD group,the duration of operation in IL-PELD group was significantly shorter,and intraoperative fluoroscopy frequency was significantly less(P<0.05).At 1 d and 1 month after treatment,the visual analogue scale(VAS)score in the two groups was significantly decreased compared with that before treatment,while the Japanese Orthopedic Association(JOA)score was significantly increased(P<0.05).At 1 d and 1 month after treatment,ODI scores of lumbar function were lower than those before treatment(P<0.05).There were no significant differences in postoperative complications between the 2 groups(P>0.05).Conclusion TF-PELD and IL-PELD have achieved satisfactory efficacy in the treatment of elderly patients with L 5S 1 LDH.Both approaches can significantly improve perioperative indicators,relieve pain and improve waist function.In addition,IL-PELD is more advantageous than TF-PELD in the improvements of duration of operation and intraoperative fluoroscopy frequency.