经皮内镜椎间孔入路手术治疗老年腰椎间盘突出症的临床分析

目的探讨经皮内镜椎间孔入路手术治疗老年腰椎间盘突出症的适应证，分析手术技术及疗效。 方法回顾性收集辽宁省抚顺市中心医院骨科2016年1月至2018年6月，采用经皮内镜椎间孔入路手术治疗单责任节段老年腰椎间盘突出症患者67例，男性24例，女性43例，年龄60~87岁，平均年龄（68±7）岁。责任节段：L_3~4间盘突出11例，L_4~5间盘突出42例，L₅~S₁间盘突出14例。病程0.5~36个月。采用疼痛视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）、改良MacNab评价临床疗效。 结果本组均顺利完成手术，手术时间60~150 min，平均（105±18）min。随访6~12个月，平均（7.5±1.6）个月。除1例症状未改善外，其余66例患者腰腿痛症状及神经功能障碍均有不同程度的缓解。术前患者腰痛VAS评分为（3.5±1.2）分，腿痛VAS评分为（8.0±1.1）分，ODI指数为（70±18），术后6~12个月随访时腰痛VAS评分为（1.7±0.9）分，腿痛VAS评分为（1.0±1.6）分，ODI指数为（17±10），差异均有统计学意义（t=13.718，t=30.973，t=23.059，均P=0.000）。按照改良MacNab评价标准，优42例，良18例，可5例，差2例，优良率89.55%。无硬膜撕裂、神经根损伤和感染，术中出现颈痛3例，术后出现下肢一过性麻木疼痛5例，下肢疼痛持续残留2例，出现对侧下肢疼痛1例，腰痛明显加重2例，复发1例。 结论具备熟练的椎间孔镜技术，掌握好手术适应证，明确责任阶段，采用经皮内镜椎间孔入路手术治疗老年腰椎间盘突出症可取得良好的近期效果。

An analysis of clinical outcomes of percutaneous endoscopic transforaminal discectomy for lumbar disc herniation in the elderly

ObjectiveTo investigate the surgical techniques and clinical effects of percutaneous endoscopic transforaminal discectomy in the treatment of lumbar disc herniation in elderly patients. MethodsA total of 67 patients with lumbar disc herniation in the elderly were treated by percutaneous endoscopic transforaminal discectomy from January 2016 to June 2018. There were 24 males and 43 females, whose average age was 68±7 years (range, 60-87 years). All cases had responsible single-level lumbar disc herniation, L_3-4 in 11 cases, L_4-5 in 42, L₅-S₁ in 14. The Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and modified MacNab criteria were used for the evaluation of clinical effects. ResultsThe operation was completed successfully in all cases, The mean operation time was 105±18 min (range: 60-150 min). The 67 patients were followed up for 6-12 months (average 7.5±1.6 months), low back and leg pain, sensory disturbance and muscle weakness were alleviated in different degrees after the operation except for 1 patient. The VAS scores of low back pain and leg pain were (3.5±1.2) and (8.0±1.1) point preoperatively, (1.7±0.9) and (1.0±1.6) point at 6-12 months after the operation. The ODI scores were (70±18) preoperatively and (17±10) at 6-12 months after the operation. Statistically significant differences existed in the VAS scores of low back and leg pain and ODI scores preoperatively and at 6-12 months after the operation (t=13.718, t=30.973, t=23.059, P=0.000). The excellent and good rate was 89.55% in the latest follow up according to the modified MacNab criteria. There were no dural tears, nerve injuries and infections. 3 patient experienced neck pain during operation. The postoperative complications included transient lower limb numbness and pain in 5 cases, persistent leg pain caused by incomplete endoscopic discectomy in 2 cases, opposite leg pain occurring in 1 case, more severe low back pain in 2 cases, reoccurrence in 1 case. ConclusionsPercutaneous endoscopic transforaminal discectomy for responsible single-level lumbar disc herniation in the elderly presents satisfactory short-term clinical outcomes due to reliable surgical technique and appropriate patients.