高龄急性根性疼痛经椎板间内镜减压治疗

Interlaminar endoscopic decompression for acute lower limb radical pain in elderly

摘要:

[目的] 探讨经皮椎板间入路椎间孔镜椎间盘切除术（percutaneous interlaminar endoscopic discectomy, PIED） 治疗高龄腰椎间盘突出症（lumbar disc herniation, LDH） 急性根性疼痛的临床疗效。[方法] 2020 年6 月—2023 年6 月采用PIED 治疗43 例高龄LDH 急性根性疼痛患者，评价临床与影像结果。[结果] 43 例患者均顺利完成手术，术中均未发生硬膜撕裂、神经根损伤及脑脊液漏等并发症。患者均获得1 年以上随访。与术前相比，术后3 个月及末次随访时，患者腰痛VAS [(6.7±1.6),(2.5±0.8), (1.6±0.8), P＜0.001]、腿痛VAS [(6.5±1.8), (2.3±1.2), (1.6±0.9), P＜0.001]、ODI [(34.2±5.6), (13.8±4.2), (9.4±2.5), P＜0.001]、JOA 评分[(10.5±2.3), (23.2±3.2), (25.1±3.0), P＜0.001] 均显著改善。影像方面，与术前相比，术后3 个月及末次随访时，椎间孔矢状径[(1.6±1.1) mm, 2.8±1.4) mm, (2.6±1.4) mm, P＜0.001] 及椎间隙高度[(6.1±1.6) mm, (10.4±1.2) mm, (9.6±0.9) mm, P＜0.001] 均显著增加，腰椎前凸角无明显变化（P＞0.05）。[结论] PIED 能有效缓解高龄LDH 急性下肢疼痛症状，是治疗高龄LDH 安全、有效的方法之一。

Abstract:

[Objective] To evaluate the clinical efficacy of percutaneous interlaminar endoscopic discectomy (PIED) for the treatmentof acute lower limb radical pain due to lumbar disc herniation (LDH) in the elderly. [Methods] From June 2020 to June 2023, 43 elderly pa-tients with acute lower limb radical pain due to LDH were treated with PIED at our institution. The clinical and imaging data were collectedand analyzed. [Results] All patients had operation performed smoothly with incision length of (0.8±0.1) cm, intraoperative blood loss of(70.3±26.4) ml, operation time of (89.3±7.6) minutes, and hospital stay of (6.9±2.6) days, while without complications, such as dural tear,nerve root injury and cerebrospinal fluid leakage. With time preoperatively, 3 months postoperatively and the latest follow-up lasted formore than one year, there were significant improvements in terms of the back pain VAS score [(6.7±1.6), (2.5±0.8), (1.6±0.8), P＜0001], legpain VAS score [(6.5±1.8), (2.3±1.2), (1.6±0.9), P＜0.001], ODI index [(34.2±5.6), (13.8±4.2), (9.4±2.5), P＜0.001], JOA score [(10.5±2.3),(23.2±3.2), (25.1±3.0), P＜0.001], sagittal foramen diameter measured on images [(1.6±1.1) mm, (2.8±1.4) mm, (2.6±1.4) mm,P ＜0.001],and intervertebral height [(6.1±1.6) mm, (10.4±1.2) mm, (9.6±0.9) mm, P＜0.001]. However, no significant changes were noted in the lum-bar lordotic angle (P＞0.05). [Conclusion] PIED provides effective relief from acute lower limb radical pain due to LDH in elderly, repre-sents a safe, effective therapeutic option for this condition.