经椎间孔入路脊柱内镜下髓核摘除术治疗老年腰椎间盘突出症的临床研究

Clinical Study on the Treatment of Senile Lumbar Disc Herniation by Endoscopic Nucleus Pulposus Excision through the Intervertebral Foraminal Approach

目的探讨经椎间孔入路脊柱内镜下髓核摘除术治疗老年腰椎间盘突出症的临床效果。方法研究中纳入对象均为山东国欣颐养集团肥城医院脊柱外科收治的老年腰椎间盘突出症患者(病例数:64例;纳入年限:2020年1~12月),将此次纳入患者采取随机分组形式均分为A、B两组,术前通过影像学方法明确患者椎间盘突出节段,并应用网格定位板进行定位;术中指导患者以侧卧位、患侧在上的体位接受治疗,合理调整穿刺方向及路线。其中,B组针对平面突出者,穿刺针接近水平;脱出型突出者则需增加穿刺针角度;A组则保持椎间盘平面与穿刺角度间为15°~45°夹角。对比观察两组患者的各项临床指标(主要观察患者的手术时间、术中出血量以及透视次数)及手术效果[主要对比患者术前术后的疼痛程度(应用VAS视觉模拟评分法评估)及功能障碍评分(应用Oswestry功能障碍指数问卷表(ODI)评估),二者均为评分越低改善效果越理想]。结果A组术中出血量(20.30±2.15)mL,手术时间(59.41±6.22)min,透视次数(12.50±3.31)次;B组术中出血量(19.77±1.56)mL,手术时间(45.86±2.94)min,透视次数(8.29±1.96)次,两组患者术中出血量对比无明显差异(P>0.05);而B组患者手术时间及透视次数对比A组则有显著降低(P<0.05)。治疗前,两组患者疼痛程度及功能障碍情况对比无差异(P>0.05);治疗后,B组患者的VAS评分及ODI评分对比A组均出现了显著降低(P<0.05)。结论在老年腰椎间盘突出症患者治疗中,应用经椎间孔入路脊柱内镜下髓核摘除术干预可有助于缩短手术时间,减少透视次数,减轻术后疼痛,促进患者术后恢复。

Objective To explore the clinical effect of endoscopic nucleus pulposus excision via transforaminal approach in the treatment of lumbar disc herniation in the elderly.Methods The subjects included in the study were all elderly patients with lumbar intervertebral disc herniation admitted to the Spine Surgery Department of Feicheng Hospital of Shandong Guoxin Yiyang Group(number of cases:64 cases;inclusion period:January 2020 to December 2020).The included patients were randomized.The patients were divided into groups A and group B.Before the operation,the segment of the herniated disc of the patient was identified by imaging methods,and the grid positioning plate was used for positioning;during the operation,the patient was instructed to receive treatment in the lateral position and the affected side up.It is reasonable adjust the puncture direction and route.Among them,for group B,the puncture needle is close to level for patients with flat protrusion;for prolapsed type,the angle of the puncture needle needs to be increased;for group A,the angle between the plane of the intervertebral disc and the puncture angle is maintained at 15°~45°.Compare and observe the clinical indicators of the two groups of patients(mainly observe the patient's operative time,intraoperative blood loss,and the number of fluoroscopy)and surgical effects[mainly compare the patient's pre-and post-operative pain level(assessed by the VAS visual analog scale)and Dysfunction score(applying Oswestry dysfunction index questionnaire(ODI)evaluation),both of which are the lower the score,the better the improvement effect].Results In group A,intraoperative blood loss(20.30±2.15)mL,operation time(59.41±6.22)min,fluoroscopy times(12.50±3.31)times;group B intraoperative blood loss(19.77±1.56)mL,operation time(45.86±2.94)min,the number of fluoroscopy(8.29±1.96)times,there was no significant difference in intraoperative blood loss between the two groups(P>0.05);while the operation time and the number of fluoroscopy in group B were significantly lower than those in group A(P<0.05).Before treatment,there was no difference in pain degree and dysfunction between the two groups(P>0.05);after treatment,the VAS score and ODI score of group B were significantly lower than those of group A(P<0.05).Conclusion In the treatment of elderly patients with lumbar disc herniation,the application of transforaminal approach spinal endoscopic nucleus pulposus intervention can help shorten the operation time,reduce the number of fluoroscopy,reduce postoperative pain,and promote postoperative recovery.