经皮椎间孔镜治疗不同年龄段腰椎间盘突出症的短期疗效对比

Comparison of Short⁃term Efficacy of Percutaneous Endoscopic Lumbar Discectomy for the Treatmentof Lumbar Disc Herniation in Different Age Patients

目的 分析比较经皮椎间孔镜间盘切除术(percutaneous endoscopic lumbar discectomy,PELD)治疗不同年龄段腰椎间盘突出症(lumbar disc herniation,LDH)的短期疗效。方法 2018年1月至8月,前瞻性纳入需行PELD治疗的107例LDH病人,以年龄为依据分组,年龄<45岁的51例纳入青壮年组,年龄≥45岁的56例纳入中老年组。术前1 d、术后1个月、1年和2年随访时采用疼痛视觉模拟量表(visual analogue scale,VAS)、Oswestry 功能障碍指数(Oswestry disability index,ODI)和改良 MacNab 标准评估治疗效果,并统计复发率。结果 两组病人均顺利完成手术。两组术后1个月、1年、2年的腰、腿痛VAS评分和腰椎ODI均较术前明显改善,差异均有统计学意义(P均<0.05)。两组间术后2年的腰、腿痛VAS评分以及术后1年、2年的ODI比较,差异均有统计学意义(P均<0.05)。青壮年组和中老年组的复发率(1.96% vs. 8.93%)比较,差异无统计学意义(P=0.209)。根据改良MacNab标准,青壮年组和中老年组的优良率分别为96.08%、91.07%。结论 PELD创伤小、疗效好,可作为青壮年病人手术治疗LDH的优选方案,同时康复快、麻醉风险小,也是中老年病人的一个可靠选择。

Objective To compare the short ⁃ term efficacy of percutaneous endoscopic lumbardiscectomy (PELD) for the treatment of lumbar disc herniation (LDH) in different age patients. Methods FromJanuary 2018 to August 2018, 107 patients with LDH who underwent PELD treatment were included in thisprospective study. A total of 51 patients with age less than 45 years old were included in the young group, and56 cases with age ≥45 years old were included in the elderly group. Surgical outcomes were evaluated by visualanalogue scale (VAS), Oswestry disability index (ODI) and modified MacNab criteria at 1st day beforeoperation, 1st month, 1st year and 2nd year after operation, and the recurrence rate was statistically analyzed.Results All patients were successfully operated. The VAS score of low back pain and leg pain and the ODI inthe two groups at 1st month, 1st year and 2nd year after operation were significantly improved as compared withthose before operation (P<0.05). The VAS scores of low back pain and leg pain at 2nd year after operation andODI at 1st year and 2nd year after operation were compared between the two groups, and the difference wasstatistically significant (P<0.05). There was no significant difference in the recurrence rate between the younggroup (1.96% ) and the elderly group (8.93% ) (P=0.209). According to the modified MacNab standard, theexcellent and good rates of young group and elderly group were 96.08% and 91.07% , respectively.Conclusion PELD should be the priority selection for surgical treatment of LDH in young patients, because ofits mild trauma and excellent efficacy, at the same time, with the rapid recovery and low risk of anesthesia, itcan also be a reliable choice for elderly patients.