椎间孔镜BEIS技术治疗合并腰椎侧凸的老年人腰椎间盘突出症的观察

目的观察经皮椎间孔镜BEIS技术治疗同时合并腰椎侧凸的老年性腰椎间盘突出症的临床疗效。方法回顾性分析2015年1月至2017年3月本科收治的合并腰椎侧凸的老年性腰椎间盘突患者40例。其中,治疗组21例,应用椎间孔镜BEIS技术行髓核摘除射频消融术;对照组19例,行腰椎后路椎板开窗减压单纯髓核摘除术。40例均通过门诊及电话进行1年的随访,对两组的切口长度、手术时间、术中出血量及住院时间进行对比;观察患者的术前、术后1 d、1个月、1年的JOA(Japanese Orthopaedic Association Scores)评分及冠状位Cobb角的变化,评价两组的临床疗效。结果治疗组的手术时间、切口长度、术中出血量及住院时间显著低于对照组,差异具有统计学意义(P<0.05),两组患者在术后疼痛JOA评分等方面相比于术前下降明显,差异有统计学意义(P<0.05),两组组间比较术后疼痛方面差异无统计学意义(P>0.05),但冠状位Cobb角差异明显,差异有统计学意义(P<0.05)。结论经皮椎间孔镜BEIS技术和单纯髓核摘除治疗合并腰椎侧凸的老年人椎间盘突出症的疗效相近,但前者恢复更快,具有创伤小、手术时间短、出血少、住院时间短及腰椎畸形恢复更佳等优势,值得临床推广。

Intervertebral foramen BEIS for lumbar disc herniation in elderly patients with lumbar scoliosis

Objective To observe the clinical effect of percutaneous transforaminal endoscopy (BEIS) in the treatment of senile lumbar disc herniation with lumbar scoliosis. Methods A retrospective analysis was made on 40 elderly patients with lumbar disc processes with lumbar scoliosis treated in our department from January 2015 to March 2017. Of them, 21 patients in the treatment group were treated by radiofrequency ablation of nucleus pulposus with BEIS technique under foraminoscope, and 19 patients in the control group were treated by posterior laminectomy and decompression and simple nucleus pulposus extraction. 40 cases were followed up for one year through outpatient and telephone. The incision length, operation time, intraoperative bleeding volume and hospitalization time were compared between the two groups. The changes of JOA (Japanese Orthopaedic Association Scores) score and coronal Cobb angle before operation, 1 day, 1 month and 1 year after operation were observed to evaluate the clinical efficacy of the two groups. Results The operation time, incision length, intraoperative bleeding volume and hospitalization time of the treatment group were significantly lower than those of the control group (P < 0.05). The JOA scores of the two groups were significantly lower than those of the preoperative group (P < 0.05). There was no significant difference in postoperative pain between the two groups (P > 0.05), but the Coronal Cobb angle was significantly different. Significant, with statistical significance (P < 0.05). Conclusion Percutaneous transforaminal endoscopy (BEIS) and nucleus pulposus excision are similar in the treatment of lumbar disc herniation in elderly patients with lumbar scoliosis, but the former has the advantages of less trauma, shorter operation time, less bleeding, shorter hospitalization time and better recovery of lumbar deformity. It is worthy of clinical promotion.