经皮椎间孔镜老年性腰椎间盘突出症患者疗效分析

Efficacy of Transforaminal Endoscopic Spine System Technique in the treatment of elderly patients with lumbar disc herniationLUAN Jing1 2, DU Hongyin1, HE Yongjin2,WANG Qi 3, LYU Dan2, WANG Zhun2

摘要:

目的 评价经皮椎间孔镜技术治疗老年性腰椎间盘突出症患者的疗效。方法 收集2018年1月至2018年12月就诊于天津市第一中心医院疼痛科年龄61~80岁老年腰椎间盘突出症患者72例(S组),平均年龄(68±5.59)岁,其中男34例,女38例,ASA分级I或Ⅱ级；对照组选取同时间段年龄40～60岁中老年腰椎间盘突出症患者41例(Y组),平均年龄(53±4.83)岁,其中男16例,女25例。两组患者均进行椎间孔镜下突出物摘除、黄韧带及后纵韧带成型、神经根松解减压,并于术前1 d和术后3 d、1、3、6、12个月时采用视觉模拟评分法VAS评分分别评价腰部及患肢疼痛程度；分别于术前1 d和术后12个月采用Oswestry功能障碍指数评定患者功能情况,采用JOA评分评价腰背痛情况；术后12月时采用MacNab分级评价手术疗效。结果 所有患者均顺利完成手术,无神经损伤、感染等严重并发症。与术前l d比较,两组患者除术后3d腰痛VAS评分较术前无变化,余各时间点腰痛及患肢痛VAS评分值均降低,差异具有统计学意义(P<0.05)；术后12个月时,两组患者Oswestry功能障碍评分及JOA指数较术前均有明显改善,差异具有统计学意义(P<0.05)；术后12个月两组患者MacNab分级优良率分别为80.5%(33/41)及77.8%(56/72)；与Y组相比,S组术后同时点VAS评分、ODI功能评分、JOA指数及术后12个月时MacNab分级差异均无统计学意义(P>0.1)。结论 椎间孔镜TESSYS技术可应用于老年腰椎间盘突出症患者,术后恢复快,优良率高。

Abstract:

Objective To evaluate the efficacy of tansforaminal endoscopic spine system techniquein in treatment of elderly patients with lumbar disc herniation. Methods From January 2018 and December 2018, 72 patients from 61 to 80 years old with lumbar disc herniation, admitted to the First Center Hospital of Tianjin, ASA I or Ⅱ were collected (group S ),with an average age of 68±5.59 years old, there were 34 males and 38 females ；In the control group,41 patients from 40 to 60 years old were collected( group Y), with an average age of 53±4.83 years old, there were 16 males and 25 females. Extirpated protrusion, plasty ligamenum flavum, posterior longitudinal ligament and nerve root decompression were carried out using TESSYS technique in the two groups. Pain in the loin and diseased leg were assessed using Visual Analogue Scale (VAS) at l day before surgery and 3 days,1,3,6 and 12 months after surgery. Patient’s function was assessed by using the Oswestry Disability Index (ODI) and JOA score at l day before surgery and 12 months after surgery.The therapeutic effect was evaluated using modified MacNab criteria at 12 months after surgery. Results All the operations were completed successfully without serious complications such as nerve injury and infection. Compared with the baseline at 1day before surgery, VAS were significantly decreased in loin and diseased leg at each time point after surgery, except loin pain in the two groups 3 days after surgery, and ODI and JOA scores were decreased at 12 months after surgery in the two groups (P<0.05). The excellent and good rate of MacNab in group Y and S were 80.5%(33/41)and 77.8 %(56/72)at twelve months after operation. There was no significant change between group Y and group S in VAS at each time point and ODI and JOA and MacNab scores at 12 months after surgery (P>0.1). Conclusion TESSYS technique can be effectively and safely applied to the treatment of elderly patients with lumbar disc herniation with fast recovery and high excellet rate.