经皮椎间孔镜在治疗中老年腰椎间盘突出症中的应用

Percutaneous transforaminal endoscopic discectomy in treatment of lumbar disc herniation for middle-aged and elderly patients

目的评价应用经皮椎间孔镜(PTED)治疗中老年腰椎间盘突出症的临床效果和价值。方法前瞻性研究分析2016年3月至2018年9月空军特色医学中心骨科采用PTED切除突出椎间盘髓核减压治疗的50~72岁腰椎间盘突出症患者,共50例,并以同期常规开放椎板开窗或半椎板切除减压突出椎间盘髓核切除手术的50~71岁患者50例为对照组。比较2组患者术中出血量、手术时间、术后住院时间。以术后1 d、1个月、3个月疼痛视觉模拟评分(VAS)和术后3个月Oswestry功能障碍指数(ODI),及术后6个月改良MacNab标准评定手术疗效。手术前及术后3~6个月行MRI检查,观察手术前后椎管及椎间盘突出的变化。使用STATA 12.0统计软件进行统计分析。结果2组患者年龄、术前VAS和ODI评分差异无统计学意义(P>0.05),术后VAS和ODI评分较术前均显著下降(P<0.01);PTED组术后1 d、1个月的VAS评分显著低于对照组(P<0.01)。术后3个月,2组VAS和ODI评分差异无统计学意义(P>0.05);术后6个月,2组改良MacNab标准评定功能差异无统计学意义(P>0.05);PTED组术中出血量、术后住院时间显著少于对照组(P<0.01);2组手术时间无统计学差异(P>0.05)。MRI检查结果显示,与术前比较,2组术后3~6个月椎间盘突出均消失或明显减小,椎管通畅、面积明显增大。结论PTED技术治疗中老年腰椎间盘突出症,中期疗效与单纯开放手术相当,但PTED早期疗效好、损伤小、恢复快、并发症少。

Objective To evaluate the clinical efficacy and value of percutaneous transforaminal endoscopic discectomy(PTED)in the treatment of lumbar disc herniation in middle-aged and elderly patients.Methods A prospective study was performed to analyze 50 patients(50 to 72 years old)with lumbar disc herniation undergoing PTED resection of the nucleus pulposus of the intervertebral disc in our department from March 2016 to September 2018.Another 50 patients aged 50-71 years who underwent fenestration or semi-laminar resection and decompression of the disc nucleus pulposus during the same period were recruited and served as control group.The intraoperative blood loss volume,operation time,postoperative length of hospital stay,pain visual analogue scale(VAS)scores at 1 day,1 and 3 months postoperatively,and Oswestry dysfunction index(ODI)at 3 months postoperatively,and results of modified MacNab criteria at 6 months postoperatively were used to assess the efficacy of surgery.MRI was performed in 3-6 months after operation to observe the changes of the spinal canal and intervertebral disc protrusion before and after operation.STATA statistics 12.0 was used to perform the statistical analysis.Results No significant difference was seen in age and VAS and ODI scores before operation between the two groups(P>0.05),but the postoperative VAS and ODI scores were significantly decreased than those before surgery(P<0.01).The VAS scores in 1 day and 1 month were significantly lower in the PTED group than the control group(P<0.01),but no such difference was observed in the scores at 3 months postoperatively(P>0.05).The results of modified MacNab criteria at 6 months after surgery indicated that there was no significant difference in the function between the two groups(P>0.05).The PTED group had less intraoperative blood loss and shorter postoperative length of hospital stay than the control group(P<0.01),and no difference in operation time(P>0.05).As shown by MRI,compared with preoperative conditions,the herniation of intervertebral disc disappeared or decreased obviously,and the spinal canal was unobstructed and the area was increased obviously in 3-6 months after operation.Conclusion PTED technique can obtain similar mid-term outcomes as open surgery in the treatment of intervertebral disc herniation in middle-aged and elderly patients.PTED has good short-term effect,less damage,quick recovery and less complications.