椎间孔镜治疗青壮年与中老年腰椎间盘突出症的疗效分析

目的对比研究经皮椎间孔镜间盘摘除术 (percutaneous endoscopic lumbar discectomy,PELD) 治疗青壮年与中老年腰椎间盘突出症 (lumbar disc herniation,LDH) 的疗效差异。方法 2017 年 5~10 月我院采用 PELD 治疗 116 例 LDH 患者,按年龄段将患者分为青壮年组 (A 组,55 例) 和中老年组 (B 组,61 例),于术前和术后 3 个月、1 年及 2 年时随访分析患者疗效及复发率,采用疼痛视觉模拟评分 (visual analogue scale,VAS)、Oswestry 功能障碍指数 (oswestry disability index,ODI) 和改进后 MacNab 标准评价手术疗效。结果两组间腰、腿痛 VAS 和 ODI 评分术前与术后 3 个月随访时差异无统计学意义 (P>0.05)。术后 1 年 A 组腰、腿痛 VAS 和 ODI 评分分别为 1.35±0.67、1.35±0.80 和 11.62±2.73,术后 1 年 B 组腰、腿痛 VAS 和 ODI 评分分别为 2.05±0.85、2.39±0.69 和 13.41±3.12,术后 2 年 A 组腰、腿痛 VAS 和 ODI 评分分别为 1.24±0.64、1.25±0.93 和 10.54±2.79,术后 2 年 B 组腰、腿痛 VAS 和 ODI 评分分别为 2.59±1.02、2.54±0.86 和 14.02±3.71。术后 1 年及 2 年随访时 A 组优于 B 组,差异有统计学意义 (P<0.05)。A、B 两组复发率分别为 1.82% (1 / 55) 和 9.84% (6 / 61),组间差异无统计学意义 (P>0.05)。按改进后 MacNab 标准 A、B 两组的优良率分别为 96.36%、90.16%。结论 PELD 治疗青壮年 LDH 疗效显著,应作为手术治疗的首选方案,中老年 LDH 也能取得满意的疗效,可避免开放手术的弊端及全身麻醉等风险。

Percutaneous endoscopic lumbar discectomy in the treatment of young and elderly patients with lumbar disc herniation

Objective To analyze the effects of percutaneous endoscopic lumbar discectomy (PELD) on the treatment of lumbar disc herniation (LDH) in young and elderly patients.Methods A total of 116 LDH patients after PELD were divided into two groups according to the age:Group A (young adults),n=55;Group B (the elderly),n=61.Surgical outcomes were evaluated by visual analogue scale (VAS),Oswestry disability index (ODI),and modified MacNab criteria 3 months,1 year,and 2 years postoperatively.Results There were no significant differences in the VAS (lumbar and leg) and ODI before operation and 3 months after operation between the two groups(P > 0.05).VAS (lumbar and leg) and ODI 1 year and 2 years after operation in Group A:(1.35±0.67),(1.35±0.80),(11.62±2.73);(1.24±0.64),(1.25±0.93),(10.54±2.79).VAS (lumbar and leg) and ODI 1 year and 2 years after operation in Group B:(2.05±0.85),(2.39±0.69),(13.41±3.12);(2.59±1.02),(2.54±0.86),(14.02±3.71).Clinical results of Group A were significantly better than Group B (P < 0.05).Recurrence rate:1.82% in Group A;9.84% in Group B;no significant differences between the two groups (P > 0.05).Excellent-good rate according to modified MacNab:96.36% in Group A;90.16% in Group B.Conclusions PELD should be listed as the first option in the treatment of lumbar disc herniation in both young and elderly patients,avoiding general anesthesia and other risks.