全可视脊柱内镜下治疗不同年龄段腰椎间盘突出症患者的近期疗效分析

Analysis of the short-term curative effect of treating lumbar disc herniation in patients of different age groups under full visual spinal endoscopy

目的探讨经皮脊柱内镜下腰椎间盘切除术治疗不同年龄段的腰椎间盘突出症患者的近期手术疗效。方法选择2019年3月—2020年3月在本院接受经皮侧镜下腰椎间盘切除术的119例患者资料进行回顾性分析,所有患者随访3个月以上,将腰椎间盘突出症患者按照年龄分为三个组:青少年组(<45岁,48例)、中年组(>45且<60岁,53例)、老年组(≥60岁,18例)。观察并记录患者一般情况,分析三组术前、术后即刻、术后1个月、术后3个月的视觉模拟评分法(VAS)、Oswestry功能障碍指数(ODI),评估患者身体恢复情况,末期随访采用改良Macnab标准进行疗效的评价。结果119例患者均顺利完成手术并完成随访,随访时间3-15个月,平均9个月。青少年组、中年组和老年组术中出血量分别为(5.58±1.98)ml、(6.68±2.57)ml和(11.28±4.04)ml,前两组均比老年组少,组间比较,差异有统计学意义(F=31.034,P<0.05)。三组术后即刻、术后1个月、术后3个月的VAS评分与ODI指数和术前比较,组内比较,差异均有统计学意义(P<0.05)。术后1个月青少年组、中年组VAS评分均低于老年组,差异有统计学意义(F=6.725,P=0.02);术后1个月青少年组、中年组ODI指数均低于老年组,差异有统计学意义(F=3.734,P=0.03)。术后3个月青少年组、中年组VAS评分均低于老年组,差异有统计学意义(F=3.391,P=0.04);术后3个月青少年组、中年组ODI指数均低于老年组,差异有统计学意义(F=5.308,P=0.01)。末次随访时采用改良MacNab标椎评价疗效,青少年组、中年组和老年组优良率分别为66.7%、71.7%和44.4%,三组间比较,差异无统计学意义(χ^(2)=0.048,P=0.60)。结论在近期的临床疗效中,经皮脊柱内镜下腰椎间盘切除术治疗不同年龄阶段的腰椎间盘突出症患者,均取得满意的结果,但是术后1个月和术后3个月内青中年患者比老年患者恢复更快。和青中年患者相比,老年患者的术中出血量更多,住院时间更长。经皮脊柱内镜下腰椎间盘切除术更适合青中年腰椎间盘突出患者的治疗。

Objective To investigate the short-term surgical effect of percutaneous spineendoscopic lumbar discectomy for lumbar disc herniation of different ages.Methods A total of 119 patients underwent percutaneous spine endoscopic lumbar discectomy in our hospital from March 2019 to March 2020 were enrolled in the study and were retrospectively analyzed,all of the patients were followed up for more than three months.Patients with lumbar disc herniation were divided into three groups according to age:adolescent group(younger than 45 years old,n=48),middle-aged group(elder than 45 and younger than 60 years old,n=53),elderly group(equal or elder than 60 years old,n=18).To observe and record the general condition of the patients,analyze the score of visual analogue scale(VAS),and Oswestry disability index score(ODI)of the three groups before operation,immediately after operation,one month after operation and three months after operation.We will evaluate the patient’s physical recovery,and use the improved Macnab standard to evaluate the curative effect at the end of follow-up.Results All 119 cases were successfully complete the operation and were followed up for 3-15 months with an average of 9 months.The intraoperative blood loss was(5.58±1.98)mL,(6.68±2.57)mL and(11.28±4.04)in the adolescent group,middle-aged group and elderly group respectively,the blood loss of adolescent group and middle-aged group were less than the elderly group,and the difference was statistically significant(F=31.034,P<0.05).The VAS scores of the three groups immediately after operation,one month after operation and three months after operation and ODI index,compared with those preoperative,all the differences were statistically significant(P<0.05).One month postoperative,the scores of VAS in the adolescent group and middle-aged group were significantly lower than that in the elderly group,the differences was statistically significant(F=6.725,P=0.02).The ODI index of the adolescent group and the middle-aged group were significantly lower than that of the elderly group,the difference was statistically significant(F=3.734,P=0.03).Three months after operation,the VAS scores in the adolescent group and middle-aged group were significantly lower than that in the elderly group,the difference was statistically significant(F=3.391,P=0.04);and the ODI index of the adolescent group and the middle-aged group were significantly lower than that of the elderly group,the difference was statistically significant(F=5.308,P=0.01).At the last follow-up,we used modified MacNab standard to evaluate the efficacy,the excellent and good rates were 66.7%,71.7%and 44.4%,respectively,comparison among the three groups indicated that the difference was not statistically significant(χ^(2)=0.048,P=0.60).Conclusions In the recent clinical efficacy,percutaneous endoscopic lumbar discectomy in treating lumbar disc herniation at different ages has achieved satisfactory results.However,at one month and three months after operation,young and middle-aged patients recovered faster than elderly patients.Compared with young and middle-aged patients,elderly patients had more intraoperative bleeding and longer hospital stay.Percutaneous endoscopic lumbar discectomy is more suitable for the treatment of young and middle-aged patients with lumbar disc herniation.