经皮椎间孔镜突出物摘除术治疗老年腰椎间盘突出症疗效不佳的原因分析

Analysis of the cause of poor curative effect of percutaneous foraminoscopic protrusion in the treatment of elderly lumbar disc herniation

摘要:

目的：探讨经皮椎间孔镜突出物摘除术（TESSYS技术）治疗老年腰椎间盘突出症疗效不佳的影响因素。方法：收集431例老年腰椎间盘突出症病人入组研究，入组病人均采用经皮椎间孔镜TESSYS技术行腰椎间盘突出物摘除、神经根松解减压术。术后12个月时采用改良MacNab疗效评定标准评估手术效果。根据手术效果，将病人分为优良组和可差组。采用多因素logistic回归分析，对可能影响手术疗效的原因进行分析。结果：至术后12个月末次随访时优175例，良132例，可85例，差39例，优良率71.23%，临床总体有效率90.95%。与术前比较，术后3天及术后1、3、6、12个月时腰痛VAS评分、下肢痛VAS评分、ODI评分、JOA评分及GAD-7评分,均较术前明显改善 (P < 0.05)；Logistic回归分析结果显示：病人体重指数、间盘退变程度、终板炎、相邻节段突出、精神因素，均为经皮椎间孔镜TESSYS技术治疗老年腰椎间盘突出症疗效不佳的独立危险因素 (P < 0.05)。结论：病人体重指数、突出物钙化、终板炎、相邻节段突出、精神因素，是影响经皮椎间孔镜TESSYS技术治疗老年腰椎间盘突出症疗效的独立危险因素。

Abstract:

Objective: To investigate the factors affecting the poor curative effect of TESSYS technique in the treatment of elderly lumbar disc herniation. Methods: 431 elderly patients with lumbar disc herniation were enrolled in the study, all of whom were treated with percutaneous foraminoscopic TESSYS technique for lumbar disc herniation and nerve root release decompression. The modified MacNab evaluation criteria were used to evaluate the surgical effect 12 months after surgery. According to the operation results, the patients were divided into good group and poor group. Multivariate logistic regression analysis was used to analyze the reasons that might affect the surgical effect. Results: Up to the end of 12 months after surgery, 175 cases were excellent, 132 cases were good, 85 cases were acceptable, 39 cases were poor, the excellent and good rate was 71.23%, and the overall clinical effective rate was 90.95%. Compared with the preoperative results, the lower back pain VAS score, lower limb pain VAS score, ODI score, JOA score and GAD-7 score were significantly improved at 3 days and 1, 3, 6 and 12 months after surgery (P < 0.05). Logistic regression analysis showed that body mass index, degree of intervertebral disc degeneration, endlaminitis, adjacent segment herniation and mental factors were independent risk factors for poor curative effect of percutaneous foraminal TESSYS technique in the treatment of elderly lumbar disc herniation (P < 0.05). Conclusion: Body mass index, herniated disc calcified, endlaminitis, protrusion of adjacent segments and mental factors are independent risk factors affecting the efficacy of percutaneous foraminal TESSYS technique in the treatment of elderly lumbar disc herniation.