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神经根阻滞结合经皮椎间孔镜治疗老年复杂腰椎间盘突出症的临床效果观察
Observation on the clinical effect of nerve root block combined with percutaneous transforaminal endoscopic surgery in the treatment of complex lumbar disc herniation in the elderly
投稿时间:2023-02-03  
DOI:10.3969/j.issn.1672-5972.2024.03.007
中文关键词:  老年腰椎间盘突出症  经皮椎间孔镜  多节段腰椎间盘突出症
英文关键词:Lumbar disc herniation in the elderly  Percutaneous transforaminal endoscopy  Multi-level lumbar disc herniation
基金项目:国家电网公司北京电力医院科研基金(Y2022002)
作者单位邮编
陈渲宇 首都医科大学电力教学医院(国家电网公司北京电力医院)骨科北京100073
首都医科大学附属北京朝阳医院骨科北京100020 
100020
张黎明 首都医科大学电力教学医院(国家电网公司北京电力医院)骨科北京100073 100073
耿源坤 首都医科大学电力教学医院(国家电网公司北京电力医院)骨科北京100073 100073
季祥 首都医科大学电力教学医院(国家电网公司北京电力医院)骨科北京100073 100073
赵辉 首都医科大学电力教学医院(国家电网公司北京电力医院)骨科北京100073 100073
靳凯锋 首都医科大学电力教学医院(国家电网公司北京电力医院)骨科北京100073 100073
仲伟涛 首都医科大学电力教学医院(国家电网公司北京电力医院)骨科北京100073 100073
张振华 首都医科大学电力教学医院(国家电网公司北京电力医院)骨科北京100073 100073
杜明奎 首都医科大学电力教学医院(国家电网公司北京电力医院)骨科北京100073 100073
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中文摘要:
      目的 探讨神经根阻滞结合经皮椎间孔镜技术治疗老年腰椎间盘突出症的临床效果。方法 选取国家电网公司北京电力医院骨科2017年1月至2021年12月65岁以上老年退变性腰椎间盘突出症患者共计65例,所有患者影像学均为复杂的多节段突出。其中,男28例,女37例,年龄在65 ~ 88岁之间,平均68.8岁。所有患者经6个月保守治疗无效后入院,入院后采用神经根阻滞判定为单一责任节段,然后使用经皮椎间孔镜手术切除突出的髓核组织。采用日本骨科学会评分(Japanese Orthopaedic Association, JOA)、腰椎功能障碍指数(Oswestry disability index, ODI)、腰部及腿部疼痛评分(visual analogue scale, VAS)评定临床效果,采用影像学观察手术节段活动度(range of motion, ROM)、腰椎整体活动度及相邻节段退变情况等一系列变化。结果 所有患者均获得随访,随访时间9 ~ 35个月。所有患者通过神经根阻滞确认责任节段后采用经皮椎间孔镜手术进行治疗,手术时间为75 ~ 120 min,平均98.5 min。患者术后临床症状均有不同程度的改善,无明显并发症。相比术前和末次随访,腰椎间盘突出症患者手术节段活动度、腰椎整体活动度均无明显变化,差异无统计学意义(P>0.05)。末次随访JOA评分、ODI指数、腰部疼痛VAS评分、腿部疼痛VAS评分,均较术前显著改善,差异有统计学意义(P<0.05)。结论 神经根阻滞可以有效判定复杂的老年多节段腰椎间盘突出的责任节段,椎间孔入路的椎间盘切除术对治疗老年腰椎间盘突出症具有椎旁肌损伤少、骨结构保存好、恢复快、手术风险低等特点。
英文摘要:
      Objective To explore the clinical effect of nerve root block combined with percutaneous transforaminal endoscopic technique in the treatment of lumbar disc herniation in the elderly.Methods A total of 65 patients with degenerative lumbar disc herniation aged over 65 years were randomly selected from the department of orthopedics of State Gird Beijing Electric Power Hospital from January 2017 to December 2021. All patients had complex multi-segmental herniation on imaging. There were 28 males and 37 females, aged between 65 and 88 years, with a mean age of 68.8 years. After 6 months of conservative treatment, all patients were admitted to the hospital. After admission, nerve root block was used to determine the single responsible segment, and then percutaneous transforaminal endoscopic surgery was used to remove the protruding nucleus pulposus tissue. The Japanese Orthopedic Association (JOA) score, Oswestry disability index (ODI), waist and leg visual analogue scale (VAS) were used to evaluate the clinical effect, and imaging was used to observe the activity of the surgical segments. A series of changes include range of motion (ROM), overall lumbar spine mobility, and adjacent segment degeneration.Results All patients were followed up for 9 to 35 months. All patients underwent a nerve root block to confirm the responsible segment, and the operation time was 75-120 min, with an average of 98.5 min. The clinical symptoms of all patients improved to varying degrees after surgery, and there were no obvious complications. Compared with preoperative and final follow-up, there was no significant change in the surgical segment mobility and overall lumbar spine mobility in patients with lumbar disc herniation, and the difference was not statistically significant (P>0.05). The JOA score, ODI index, waist VAS score, and leg VAS score at the last follow-up were all significantly improved compared with those before surgery, and the difference was statistically significant (P<0.05).Conclusion Nerve root block can effectively determine the responsible segment for complex multi-segment lumbar disc herniation in the elderly. Intervertebral foraminal discectomy is effective in treating lumbar disc herniation in the elderly with less paravertebral muscle damage, good bone structure preservation, and rapid recovery, low surgical risk and other characteristics.
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