射频消融技术治疗老年腰椎间盘突出症的康复评定及预后分析

Rehabilitation evaluation and prognosis analysis of radiofrequency ablation technology for the elderly patients with lumbar disc herniation

老年腰椎间盘突出症(LDH)患者的手术策略须兼顾安全性、功能康复及预后情况。以经椎间孔腰椎椎间融合术(MIS-TLIF)和椎间孔镜射频消融术(RF)后的单纯性LDH老年患者为研究对象,通过比较2种微创技术的安全性、术后功能康复与预后质量,旨在评价椎间孔镜RF对老年LDH患者的术后康复和预后的价值与优势。采用围手术期指标来评估手术安全性,采用术后1年时的腰椎活动受限率、腰痛(LBP)复发率作为功能康复指标,采用术后1年时的疼痛视觉模拟量表(VAS)、LDH相关症状的日本骨科协会(JOA)评分、生活质量的Oswestry功能障碍指数(ODI)作为预后指标。结果显示,RF组围手术期并发症发生率、康复期间的腰椎活动受限率、预后ODI评分均显著低于MIS-TLIF组,而2组的LBP复发率、VAS评分、JOA评分无显著差异,说明椎间孔镜RF治疗老年单纯性LDH具有降低围手术期并发症、促进术后康复、提高预后生活质量的优势。

Surgical strategy should be planned with a balance of safety,functional recovery,and prognosis for the elderly patients with lumbar disc herniation(LDH).This study compares two minimal-invasive techniques for treating elderly LDH patients,i.e.,the minimal-invasive transforaminal lumbar interbody fusion(MIS-TLIF)and spinal endoscopy radiofrequency ablation(RF)in terms of safety,postoperative functional recovery,and prognosis quality,aiming to evaluate the application value of RF in postoperative rehabilitation and functional prognosis for elderly patients.The peri-operative parameters are used as the safety indicators,the rates of limited lumbar range of motion,recurring low back pain(LBP)at postoperative 1y are used to evaluate the rehabilitation level,and the visual analogue scale(VAS)for pain,Japanese Orthopaedic Association(JOA)score for the LDH related symptoms,as well as the Oswestry disability index(ODI)for quality of life are used as the prognosis indicators.The results show that the rate of perioperative complication,rate of limited lumbar range of motion,and prognostic ODI in the RF group are significantly lower than those in the MIS-TLIF group,while there are no significant differences in the rate of recurring LBP,VAS,and JOA score between the two groups.It indicates that the RF has the advantages of reducing perioperative complications,promoting postoperative recovery,and improving the prognostic quality of life for treating elderly patients with simple LDH.