经皮脊柱内镜手术治疗高龄患者腰椎间盘突出症39例及1年随访结果分析

Percutaneous Spinal Endoscopic Surgery for the Treatment of 39 Elderly Patients with Lumbar Disc Herniation and 1-Year Follow-up Results Analysis

目的:分析采用经皮脊柱内镜技术治疗的39例高龄腰椎间盘突出症患者的12个月随访资料,评价手术安全性及临床疗效。方法:回顾性分析2020至2021年采用经皮脊柱内镜技术治疗的高龄腰椎间盘突出症患者39例,统计患者手术时间、术中出血量、透视次数、围手术期并发症,比较患者术前及术后第2天、1个月、6个月和12个月随访时腿痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)评分和日本骨科协会(JOA)评分,采用改良MacNab标准评价手术疗效。结果:所有患者均顺利完成手术,平均手术时间68.9 min,术中平均出血量为40.8 mL。术中每个患者平均透视约12.1次,围手术期无严重神经损伤及内科基础疾病并发症发生。患者术后各时间点VAS及ODI评分较术前降低,JOA评分较术前升高,差异有统计学意义(P<0.01)。按照改良MacNab标准评价,术后12个月优30例,良5例,可3例,差1例,优良率为89.7%(35/39)。结论:脊柱内镜技术治疗高龄患者腰椎间盘突出症疗效满意,安全性高,手术时间短,无严重不良并发症发生,是开放手术的一种理想替代方案。

Objective:To analyze the 1-year follow-up data of 39 elderly patients with lumbar disc herniation treated with percutaneous spinal endoscopy,and to evaluate the safety and clinical efficacy of surgery.Methods:A retrospective analysis was performed for 39 elderly patients with lumbar disc herniation treated by percutaneous spinal endoscopy from 2020 to 2021,and the operation time,intraoperative blood loss,fluoroscopy number and perioperative complications were analyzed,and the visual analogue scale(VAS)score,Oswestry disability index(ODI)and Japanese orthopaedic association(JOA)score of leg pain were compared at the preoperative,2nd day,1 month,6 months and 12 months follow-up of the patients after operation,and the efficacy of surgery was evaluated according to the modified MacNab criteria.Results:All patients successfully completed the operation,with an average operation time of 68.9 min and an average intraoperative blood loss of 40.8 mL.The average fluoroscopy of each patient was about 12.1 times during the operation,and there was no serious nerve injury or complications of underlying medical diseases in the perioperative period.The VAS and ODI scores of the patients were significantly lower than those before operation,and the JOA score was higher than that before operation(P<0.01).According to the evaluation of modified MacNab criteria,30 cases were excellent,5 cases were good,3 cases were acceptable,and 1 case was poor 12 months after operation,and the excellent rate was 89.7%(35/39).Conclusion:Spinal endoscopy is an ideal alternative to open surgery for the treatment of lumbar disc herniation in the elderly patients,with satisfactory efficacy,high safety,short operation time and no serious adverse complications.