椎间孔镜BEIS技术用于60岁以上腰椎手术失败综合征的观察

Application of intervertebral foramen endoscopy BEIS technique in the lumbar spine surgery failure syndrome over 60 years old

目的:评价BEIS(broad easy immediate surgery)技术行椎间孔镜下髓核摘除射频消融术治疗60岁以上腰椎手术失败综合征的中期疗效。方法:对2010年1月至2015年1月收治的40例60岁以上的腰椎手术失败综合征患者的临床资料进行回顾性分析,其中男34例,女6例,年龄60~76岁,平均66岁,病程10个月~4年。根据两组治疗方法的不同分为BEIS组和翻修组,BEIS组用BEIS技术行椎间孔镜下髓核摘除射频消融术,翻修组行经椎间孔腰椎椎体间融合术(transforaminal lumbar interbody fusion,TLIF)进行腰椎翻修。两组的性别、年龄、病程、手术节段对比,差异无统计学意义(P>0.05),观察两组患者的手术时间、术中出血量、卧床时间、住院时间;术前与术后1个月、1年和3年采用视觉模拟评分(visual analogue scale,VAS)、日本骨科协会评分(Japanese Orthopaedic Association Score,JOA)对两组疗效进行比较。结果:BEIS组的手术时间为(60.2±10.3) min、术中出血量为(60.1±4.5) ml、术后卧床时间为(2.2±1.5) d、住院时间为(4.04±1.40) d,均显著低于翻修组(P<0.05)。两组患者术后不同时间段的疼痛VAS、JOA评分较术前明显改善(P<0.05),且两组比较差异有统计学意义(P<0.05)。结论:运用BEIS技术行椎间孔镜下髓核摘除射频消融术治疗60岁以上腰椎手术失败综合征疗效较TLIF翻修手术更好,且手术时间短、出血少,卧床及住院时间明显缩短,值得临床推广。

Objective:To evaluate the mid-term efficacy of radiofrequency ablation of nucleus pulposus by intervertebral foramen endoscopy BEIS technique in the treatment of lumbar spine surgery failure syndrome over 60 years old.Methods:The clinical data of 40 patients over 60 years old with lumbar spine surgery failure syndrome admitted from January 2010 to January 2015 were retrospectively analyzed.Among them,there were 34 males and 6 females,aged from 60 to 76 years old with an average of 66 years,the courses of disease ranged from 10 months to 4 years.The patients were divided into two groups(BEIS group and revision group)according to the different surgery.The intervertebral foramen endoscopy BEIS technique and the transforaminal lumbar interbody fusion(TLIF)were performed in BEIS group and revision group respectively.There was no significant difference in general data such as sex,age,course of disease,surgical segment between two groups(P>0.05).The operation time,intraoperative bleeding volume,bed rest time after operation and hospitalization time were observed between two groups.At preoperative,postoperative 1 month,1 year,3 years,visual analogue scale(VAS)and Japanese Orthopaedic Association Score(JOA)were used to compare the efficacy.Results:The operation time,intraoperative bleeding volume,bed rest time after operation and hospitalization time in BEIS group were(60.2±10.3)min,(60.1±4.5)ml,(2.2±1.5)d,(4.04±1.40)d,respectively,which were significantly lower than those of revision group(P<0.05).The VAS and JOA scores of the two groups at different time after operation were significantly improved(P<0.05),and there was statistically significant difference between two groups(P<0.05).Conclusion:Radiofrequency ablation of nucleus pulposus by intervertebral foramen endoscopy BEIS technique is more effective than TLIF revision in the treatment of lumbar spine surgery failure syndrome over 60 years old.It has advantages of shorter operation time,less bleeding,shorter bed rest after operation and hospitalization time,and is worthy of clinical promotion.