刘晓强 吴华明 谢惠

【摘要】 目的 探讨经皮椎间孔镜（PTED）术治疗老年性腰椎管狭窄症的临床疗效。方法 将2015年7月～2016年8月骨外科收治的96例老年性腰椎管狭窄症患者，根据手术意愿分为研究组和对照组，各48例；对照组采取传统切开减压及椎间融合术治疗，研究组采取PTED术治疗，对比两组手术时间、术后卧床时间、住院时间及术中出血量，应用视觉模拟法（VAS）评价两组患者术后0.5 d、1 d、3 d、7 d的疼痛程度，术后随访1年，根据腰椎功能Macnab标准评价腰椎功能。结果 研究组手术时间、术后卧床时间及住院时间均显著短于对照组，术中出血量显著少于对照组，比较差异有统计学意义（P<0.001）。研究组术后0.5 d、1 d、3 d、7 d的VAS评分均低于对照组，比较差异有统计学意义（P<0.001）。术后两组患者均接受1年随访，基于腰椎功能Macnab标准进行评测，研究组的腰椎功能优于对照组，比较差异有统计学意义（P<0.01）。结论 采用PTED术治疗老年性腰椎管狭窄症，手术时间短，微创伤，术后恢复快，预后良好，值得推广。

【关键词】 经皮椎间孔镜；老年性腰椎管狭窄症；腰椎功能

中图分类号：R687.3 文献标识码：A DOI：10.3969/j.issn.1003-1383.2018.03.019

【Abstract】 Objective To explore the clinical effect of percutaneous transforaminal endoscopic discectomy（PTED） in the treatment of senile lumbar spinal stenosis.Methods 96 elderly patients with lumbar spinal stenosis admitted to Department of Orthopaedics from July 2015 to August 2016 were divided into study group and control group according to surgical will，with 48 cases in each group.The control group were treated with traditional incision decompression and interbody fusion，and the study group were treated with PTED.Then，operative time，postoperative bed time，hospital stay and intraoperative blood loss were compared between the two groups.And visual analogue scale （VAS） was used to evaluate pain level of the two groups at 0.5 d，1 d，3 d and 7 d after operation.All patients were followed up for 1 year to evaluate lumbar function according to Macnab standard of lumbar function.Results Operative time，postoperative bed time and hospital stay of the study group were significantly shorter than those of the control group，and intraoperative blood loss was significantly less than that of the the control group，difference was statistically significant（P<0.001）.The VAS scores at 0.5 d，1 d，3 d and 7 d after operation in the study group were significantly lower than those in the control group，difference was statistically significant（P<0.001）.Both groups were followed up for 1 year，based on the Macnab standard of lumbar function，the lumbar function of the study group was better than that of the control group，difference was statistically significant（P<0.01）.Conclusion PTED is an effective method for the treatment of senile lumbar spinal stenosis with short operation time，minimal injury，quick recovery and good prognosis，which is worth popularizing.

【Key words】 PTED；senile lumbar spinal stenosis；lumbar function

老年性腰椎管狹窄症是临床常见腰椎病症，是多种因素造成的腰椎管容积缩小及神经根管或者侧隐窝狭窄，进而使相应的脊髓、脊神经根等受压出现的神经功能障碍，如未得到及时有效治疗，可能致生活能力丧失，对患者健康和生活质量造成极大影响[1]。当前，该病以手术治疗为主，传统椎板切开减压结合椎间融合术可有效改善症状，但创伤较大，术后恢复较慢，整体预后不理想。近年来，随着腔镜技术发展，椎间孔镜手术凭借微创伤、痛苦小、恢复快等优势，在腰椎病变手术治疗中逐步应用开来，并取得显著效果。笔者分析96例老年性腰椎管狭窄症患者的手术治疗情况，探讨经皮椎间孔镜（PTED）术的临床效果，报告如下。……