经皮骨水泥椎间融合术与骨水泥椎间盘成形术治疗老年腰椎间盘突出症的疗效比较

Percutaneous cement interbody fusion versus percutaneous cement discoplasty for painful lumbar disc herniation in elderly patients: a comparison study

目的探讨经皮骨水泥椎间融合术(PCIF)治疗老年腰椎间盘突出症的初步临床价值,并与经皮骨水泥椎间盘成形术(PCD)作比较。方法回顾性分析2013年1月至2019年11月37例老年腰椎间盘突出症的患者,其中29例采用PCIF治疗(A组),8例采用PCD治疗(B组)。A组包括L3~4椎间盘节段4例、L4~5椎间盘节段20例、L5~S1椎间盘节段5例;B组包括L3~4椎间盘节段1例、L4~5椎间盘节段6例、L5~S1椎间盘节段1例。通过比较患者术前及术后Macnab标准、视觉模拟评分(VAS)和Oswesty功能障碍指数(ODI)评分的变化来评价疼痛、日常运动功能状况的改善情况。结果上述37例患者均获得手术成功。两组患者术后VAS、ODI评分变化均较术前有明显改善(P<0.05);A组患者在术后1、3、6个月和1年VAS和ODI评分均低于B组(P<0.05),邻近椎体骨折发生率低于B组(P<0.05)。结论PCIF和PCD均为治疗老年腰椎间盘突出症微创、安全、有效的方法,但PCIF较PCD能明显降低术后邻近椎体骨折的发生率,且长期临床疗效更优。

Objective To preliminarily discuss the clinical value of percutaneous cement interbody fusion(PCIF)in treating painful lumbar disc herniation in elderly patients,and to compare its clinical effect with that of percutaneous cement discoplasty(PCD).Methods The clinical data of 37 elderly patients with painful lumbar disc herniation,who were admitted to authors’hospital during the period from January 2013 to November 2019 to receive treatment,were retrospectively analyzed.Of the 37 patients,29 received PCIF(group A)and 8 received PCD(group B).In group A,the diseased intervertebral disc segments included L3-4(n=4),L4-5(n=20)and L5-S1(n=5).In group B,the diseased intervertebral disc segments included L3-4(n=1),L4-5(n=6)and L5-S1(n=1).The preoperative and postoperative Macnab classification,visual analog scale(VAS)score and Oswesty dysfunction index(ODI)score were used to evaluate the improvement of pain and function status of daily activities.Results Successful interventional operation was accomplished in all the 37 patients.In both groups,the postoperative VAS score and ODI score were significantly improved when compared with the preoperative ones(P<0.05).All the postoperative one-month,3-month,6-month and one-year VAS scores and ODI scores as well as the incidence of adjacent vertebral fractures in group A were lower than those in group B(P<0.05).Conclusion For the treatment of lumbar disc herniation in elderly patients,both PCIF and PCD are minimally-invasive,safe and effective methods,but PCIF is superior to PCD in remarkably reducing the incidence of adjacent vertebral fractures and in obtaining a better long-term clinical effect.(J Intervent Radiol,2021,30:264-269).