腰椎间孔内镜治疗高龄腰椎管狭窄症短期疗效的初步研究  

A preliminary study on short-term curative effect of percutaneous transforaminal endoscopic discectomy for lumbar spinal stenosis in elderly patients

作　　者：周春[1] 李新锋[1] 

机构地区：[1]上海交通大学医学院附属仁济医院骨科,上海200127

出　　处：《中国骨与关节外科》2017年第2期95-99,共5页Chinese Journal of Bone and Joint Surgery

摘　　要：背景:随着我国人口加速老龄化,高龄腰椎管狭窄症患者日益增多。目前对于腰椎间孔内镜治疗高龄腰椎管狭窄症的疗效仍存在争议。目的:分析腰椎间孔内镜治疗高龄腰椎管狭窄症患者的短期疗效。方法:选取我科31例经腰椎间孔内镜治疗的高龄腰椎管狭窄症患者。男17例,女14例;年龄75~97岁,平均(79.6±5.1)岁。根据患者术前、术后第1天及术后3个月、术后1年随访时的VAS、JOA评分与改良Mac Nab疗效评定标准评估治疗效果。结果:患者术后第1天、3个月及1年的下肢痛VAS评分及JOA评分优于术前(P<0.05);术后3个月及术后1年的腰痛VAS评分优于术前及术后第1天,术后第1天腰痛VAS评分高于术前,差异均具有统计学意义(P<0.05)。根据改良Mac Nab疗效评定标准,术后1年的治疗优良率高达83.9%。无一例患者在围手术期出现基础疾病加重或发生手术相关并发症。结论结论:腰椎间孔内镜术是治疗高龄腰椎管狭窄症的一种安全、有效的微创术式,特别是针对合并有基础疾病的高龄患者,具有显著优势。Background：With the acceleration of ageing in China, more elderly are suffering from lumbar spinal stenosis. The efficacy of percutaneous transforaminal endoscopic discectomy （PTED） for lumbar spinal stenosis in elderly patients is still controversial. Objective：To analyze short-term outcomes of PTED for lumbar spinal stenosis in elderly patients. Methods： Totally 31 elderly patients with lumbar spinal stenosis treated by PTED were enrolled in this study. There were 17 males and 14 females with an average age of （79.6±5.1） years （range, 75-97 years）. Visual analogue scale （VAS） score, Japanese Orthopaedic Association （JOA） score, and modified MacNab evaluation criteria were used to assess clinical outcomes before surgery, on the first day, 3 months and 1 year after surgery. Results：VAS for leg and JOA score was improved on each time point of follow-up as compared with preoperative ones （P〈0.05）. VAS for back at 3 months and 1 year after surgery was significantly lower than that before surgery and on the first day after surgery （P〈0.05）. VAS for back in first day after surgery was higher than that before surgery （P〈0.05）. The excellent and good rate of treatment was up to 83.9%in 1 year after surgery according to modified MacNab evaluation criteria. No surgery-related complications or underlying diseases exacerbation occurred in any of the 31patients in perioperative period. Conclusions：PTED is a safe and effective minimal invasive therapy technique for lumbar spinal stenosis in elderly patients. It has a remarkable advantage for elderly patients with underlying diseases.

关 键 词：腰椎间孔内镜 高龄患者 腰椎管狭窄症 

分 类 号：R687.3[医药卫生—骨科学]