经皮椎间孔脊柱内镜技术治疗高龄腰椎间盘突出症的疗效分析

A study on the effect of modified percutaneous transforaminal spine endoscopy in the treatment of the elder with lumbar disc herniation

中文关键词:  经皮椎间孔脊柱内镜技术  腰椎间盘突出症  临床效果

英文关键词:Percutaneous transforaminal spine endoscopy  Lumbar disc herniation  Clinical effect

中文摘要:

  【摘要】 目的：探讨经皮椎间孔脊柱内镜技术治疗高龄腰椎间盘突出患者的临床效果。方法：2016年3月～2019年3月我院收治的确诊为腰椎间盘突出症高龄患者130例，根据手术方式不同分为对照组和观察组，每组65例。对照组男37例，女28例，平均年龄66.4±5.3岁（61～75岁）；给予椎板开窗髓核摘除术治疗；观察组男35例，女30例，平均年龄66.9±5.3岁（62～77岁），采用经皮椎间孔脊柱内镜技术治疗。术后收集两组数据，在不同角速度（60°/s和120°/s）下检测腰背肌生物力学性能，包括背部屈伸比（flexion extension ratio，F/E）、前降力矩（peak torque，PT）及平均功率（average power，AP）；以投影栅轮廓法检测脊柱对称性，包括旋转角（RA）、侧弯角（M）及侧屈角比（LR）；采用Oswestry功能障碍指数（Oswestry disability index，ODI）评分和MacNab标准评价术后患者治疗效果。结果：两组术前各指标比较无显著性差异（P＞0.05），观察组术后F/E[（72.16±20.17）％]、PT（86.54±15.39Nm）和AP（43.27±15.68W）较术前[（86.59±23.46）%、72.10±16.39Nm和28.41±16.34W]明显改善（P＜0.05），与对照组[（79.64±21.40）％、80.14±15.64Nm和37.69±14.38W）比较差异有显著性（P＜0.05）；RA、M及LR观察组术后低于对照组（P＜0.05）；对两组患者分别随访12个月，两组患者术后ODI值均降低，且术后观察组低于对照组（P＜0.05）。随访6个月及12个月时，对照组MacNab标准优良率分别为67.69%和72.31%，观察组分别为87.69%和93.85%，两组差异有统计学意义（P＜0.05）。结论：经皮椎间孔脊柱内镜技术对高龄腰椎间盘突出症患者的治疗，在腰背肌生物力学性能、脊柱对称性恢复方面有较高的应用价值，临床疗效优于椎板开窗髓核摘除术。

英文摘要:

  【Abstract】 Objectives: To explore the clinical effect of modified percutaneous transforaminal spine endoscopy in the treatment of elderly patients with lumbar disc herniation. Methods: 130 patients with advanced lumbar disc herniation were selected from March 2016 to March 2019, and were randomly divided into control group and observation group, with 65 cases in each group. The control group included 37 males and 28 females, averaged 66.4±5.3(61-75) years old, and they were treated with fenestration discectomy. The observation group had 35 males and 30 females, averaged 66.9±5.3(62-77) years old, and they were treated with modified percutaneous transforaminal spine endoscopy. The biomechanical properties of the low back muscles measured at 60°/s and 120°/s angular velocity were analyzed, included flexion extension ratio(F/E), peak torque(PT) and average power(AP). The spinal symmetry was also analyzed, included RA, M and LR. The postoperative patients were evaluated by Oswestry disability index(ODI) score and MacNab criteria. Results: There was no significant difference in preoperative indexes between the two groups(P＞0.05). The postoperative F/E[(72.16±20.17)％], PT(86.54±15.39Nm) and AP(43.27±15.68W) of observation group obviously improved compared with that preoperatively[(86.59±23.46)%, 72.10±16.39Nm and 28.41±16.34W](P＜0.05), and there was significant difference compare with that of the control group[(79.64±21.40)%, 80.14±15.64Nm and 37.69±14.38W](P＜0.05). RA, M and LR were lower in observation groups than those in control group after operation(P<0.05). The two groups of patients were followed up for 12 months respectively. The postoperative ODI values of the two groups of patients were reduced, with that of observation group lower than that of control group(P<0.05); the control group was followed up for 6 months and 12 months. They were 67.69% and 72.31%. At 6 months and 12 months follow-up, the excellent and good rates according to the MacNab standard in the control group were 67.69% and 72.31%, and in the observation group were 87.69% and 93.85%, respectively. The difference between the two groups was statistically significant(P<0.05). Conclusions: Modified percutane-ous transforaminal spine endoscopy has high application value in the treatment of elderly patients with lumbar disc herniation judged by biomechanical properties of the back muscles and spinal symmetry, and the ODI score and the MacNab criteria were superior to fenestration discectomy.