| Background With the arrival of the aging society and the continuous extension of life expectancy,more and more elderly patients with lumbar spinal stenosis begin to appear in clinic.Most of the elderly patients with lumbar spinal stenosis have severe lumbar degeneration,often accompanied by osteoporosis and other basic diseases.Conservative treatment is often difficult to achieve satisfactory results,and surgery has become the main way to solve the clinical symptoms of the patients.At present,the operation for lumbar spinal stenosis is mainly based on lumbar fusion and internal fixation,but the elderly patients with lumbar spinal stenosis are often accompanied by many other basic diseases,and the risk of anesthesia is also high.Some patients are difficult to tolerate general anesthesia,and the emergence of minimally invasive surgery technology alleviates this contradiction,but how to achieve the best surgical effect and alleviate patients' symptoms under minimally invasive conditions.It has become the goal pursued by all clinicians.With the continuous understanding of spinal endoscopy and the continuous development of surgical instruments,PTED has become more and more mature and widely used in clinic,from the initial simple treatment of herniated intervertebral disc.gradually developed into the release of the nerve heel and the expansion of decompression and shaping of the spinal canal.Although the technique of PTED has been used in the treatment of lumbar spinal stenosis,what are its advantages and disadvantages compared with traditional surgical methods,what are the similarities and differences in surgical effects for elderly patients with lumbar spinal stenosis,and how to choose appropriate surgical indications? theseproblems still need to be further studied and discussed.Methods From July 2017 to December 2018,51 cases diagnosed with lumbar spinal stenosis were were retrospectively analyzed.and all cases are older than 75 years old.Depending on the mode of operation,the cases were divided into two groups: group A(observation group)was treated by PTED and group B(control group)was treated by traditional interlaminar fenestration decompression.The length of incision,the time of operation,the amount of blood loss,the days of hospitalization and the cost of hospitalization were analyzed.The leg pain VAS(Visual Analogue Scale)score,JOA(Japanese Orthopaedic Association Scores)score and ODI(Oswestry Disability Index)function index of the cases before and after operation(including 1 month,3 months,6 months and the last follow-up)were compared to evaluate the short-term efficacy of different surgical methods.At the last follow-up,the modified Macnab evaluation was used to evaluate the surgical effect.Objective To compare the short-term clinical effects of interlaminar fenestration decompression and percutaneous transforaminal endoscopic discectomy in the treatment of elderly patients with lumbar spinal stenosis,and to analyze the advantages and disadvantages of different surgical methods.Explore the "personalized" treatment plan for different types of patients,in order to provide reference for clinicians for the formulation of treatment plan.Results The operations of the two groups were performed by chief physicians in our hospital,all operations were completed successfully,and there were no anesthesia and surgical accidents.There was no significant difference in sex,age,course of disease,distance of claudication,hospitalization cost,operation segment and postoperative follow-up time between the two groups(P>0.05).The postoperative hospital stay in group A was significantly shorter than that in group B(P<0.05).In group A,the intraoperative blood loss was(43.0±14.3)ml,the operation time was(66.4±7.3)min,and the length of incision was(1.1±1.2)cm.In group B,the intraoperative blood loss was(76.5 ±16.7)ml,the operation time was(69.6 ±9.4)min,the length of incision was(6.7 ±0.8)cm.The amount of intraoperative bleeding in group A was significantly less than that in group B(P<0.05).The length of incision in group A was significantly shorter than that in group B(P<0.05).The operation time of group A was similar to that of group B,and there was no significant difference between group An and group B(P>0.05).The VAS score of leg pain in the two groups at post-operation 1 month,post-operation 3 months,post-operation 6 months and the last follow-up were significantly improved as compared with those before operation,and there was significant difference between the two groups(P < 0.05).At post-operation 1 month and post-operation 3 months,the VAS score of leg pain in group A was significantly lower than that in group B(P<0.05).The VAS scores of leg pain in the two groups were similar at post-operation 6 months and the last follow-up,but there was no significant difference between the two groups(P>0.05).Time had significant effect on VAS score of leg pain(F=600.248 P<0.05).There was interaction between time and operation mode(F= 7.197 P<0.05).The VAS score in different groups was significantly different(F = 3.939 P<0.05).The ODI index in the two groups at post-operation 1 month,post-operation 3 months,post-operation 6 months and the last follow-up were significantly improved as compared with those before operation,and there was significant difference between the two groups(P<0.05).At post-operation 1 month and post-operation 3 months,the ODI index in group A was significantly lower than that in group B(P<0.05).The ODI index in the two groups were similar at post-operation 6 months and the last follow-up,but there was no significant difference between the two groups(P>0.05).Time had significant effect on ODI index(F=3967 P<0.05).There was interaction between time and operation mode(F= 15.589 P<0.05).The ODI index in different groups was significantly different(F =19.771 P<0.05).The JOA score in the two groups at post-operation 1 month,post-operation 3 months,post-operation 6 months and the last follow-up were significantly improved as compared with those before operation,and there was significant difference between the two groups(P<0.05).At post-operation 1 month and post-operation 3 months,JOA score in group A was significantly lower than that in group B(P<0.05).The JOA score in the two groups were similar at post-operation 6 months and the last follow-up,but there was no significant difference between the two groups(P>0.05).Time had significant effect on JOA score(F=551.7 P<0.05).There was interaction between time and operation mode(F= 3.548 P<0.05).The JOA score in different groups was significantly different(F =8.932 P<0.05).At the last follow-up,the surgical effect was evaluated according to the modified Macnab evaluation.In group A,20 cases were excellent,2 cases were good,3 cases were fair,and the excellent and good rate was 88%.In group B,20 cases were excellent,2 cases were good,4 cases were fair,and the excellent and good rate was 85%.There was no significant difference in postoperative excellent and good rate between the two groups(P<0.05).The incidence of postoperative complications was similar between group A and group B,and there was no significant difference between group A and group B(P>0.05).Conclusion Interlaminar fenestration decompression and PTED are effective in the treatment of elderly patients with lumbar spinal stenosis,but there is no significant difference in short-term effect.Compared with Interlaminar fenestration decompression,PTED has the advantages of less surgical trauma,faster postoperative recovery and less hospital stay.There is no significant difference in the incidence of postoperative complications between the two surgical methods,and the two surgical methods are safe and effective. |
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