椎间孔镜可视环锯治疗老年腰椎间盘突出症  

Visual trephine used in percutaneous endoscopic transforaminal discectomy for senile lumbar disc herniation

作　　者：杨扬[1] 孔鹏[2] 魏传付 汲长蛟[2] 何建刚 高成 张建新[2] YANG Yang;KONG Peng;WEI Chuan-fu;JI Chang-jiao;HE Jian-gang;GAO Cheng;ZHANG Jian-xin(Shandong University of Chinese Medicine,Jinan 250014,China;The Affiliated Hospital,Shandong University of Traditional Chinese Medicine,Jinan 250014,China;Peopled Hospital of Yengisar,Xinjiang 844500,China)

机构地区：[1]山东中医药大学,山东济南250014 [2]山东中医药大学附属医院,山东济南250014 [3]英吉沙县人民医院,新疆英吉沙844500

出　　处：《中国矫形外科杂志》2021年第11期971-975,共5页Orthopedic Journal of China

摘　　要：[目的]比较经皮椎间孔镜可视环锯与骨钻治疗老年腰椎间盘突出症的临床疗效。[方法]回顾性分析本院2017年8月—2019年10月行经皮椎间孔镜间盘切除术(percutaneous endoscopic discectomy,PETD)治疗的87例老年腰椎间盘突出症患者资料,其中42例应用可视环锯,45例应用骨钻。比较两组围手术期、随访及影像资料。[结果]两组患者均顺利完成手术,未发生严重并发症。环锯组在透视次数、通道建立时间显著低于骨钻组(P<0.05);环锯组骨去除量、出血量显著高于骨钻组(P<0.05);两组切口长度、镜下操作时间、住院时间差异无统计学意义(P>0.05)。两组VAS和ODI评分均随时间延长而降低,均较术前显著改善(P<0.05),两组相同随访点VAS和ODI评分以及末次随访改良MacNab评价优良率差异均无统计学意义(P>0.05);影像方面,环锯组术后椎间孔面积显著高于骨钻组(P<0.05),两组术后3、12个月随访未见病椎不稳发生。[结论]经皮椎间孔镜可视环锯治疗老年腰椎间盘突出症具有操作简单、时间短及透视次数少等优点。[Objective]To compare the clinical outcomes of visual trephine versus bone drill used in percutaneous endoscopic transforaminal discectomy for lumbar disc herniation in the elderly.[Methods]A retrospective study was conducted on 87 elderly patients who underwent percutaneous endoscopic discectomy(PETD)for lumbar disc herniation in our hospital from August 2017 to October 2019.Of them,42 patients had foraminoplasty done with visual trephine,while the remaining 45 patients were with bone drill.The perioperative period,follow-up and imaging data of the two groups were compared.[Results]The operation was completed successfully in both groups with no serious complications.The trephine group proved significantly superior to the drill group regarding number of fluoroscopy and the time of channel establishment(P<0.05),despite of the fact that the trephine group had significantly greater amount of bone removal with more blood loss than the bone drill group(P<0.05).However,there was no significant difference in incision length,endoscopic operation time and hospital stay between the two groups(P>0.05).The VAS scores for leg pain and lower back pain,as well as ODI score significantly decreased over time,with significant improvements postoperatively compared with those before operation in both groups(P<0.05),but there was no significant difference in abovementioned scores at any corresponding time point,as well as excellent and good rate of clinical outcome graded by MacNab.s criteria at the latest follow-up between the two groups(P>0.05).In terms of imaging evaluation,the area of intervertebral foramen in the trephine group was significantly higher than that in the drill group(P<0.05),and no signs of involved segment instability were found on dynamic radiographs in both groups at 3 months and 12 months after operation.[Conclusion]The visual trephine used in percutaneous endoscopic transforaminal discectomy for senile lumbar disc herniation has the advantages of simple operation,short time and less times of fluoroscopy.

关 键 词：老年人 腰椎间盘突出症 经皮椎间孔镜间盘切除术 可视环锯 

分 类 号：R681.53[医药卫生—骨科学]