Objective To study the therapeutic effect of percutaneous transforaminal endoscopic discetomy TESSYS technique in the treatment of sequestered lumbar disc herniation combined with spinal canal stenosis in elderly patients. Method 32 patients accepted percutaneous transforaminal endoscopic discetomy TESSYS technique treatment in our hospital from January 2014 to January 2016 were enrolled in TESSYS group, and another 32 patients accepted conventional surgery were enrolled in open surgery group. Vsual analogue scale (VAS) was recorded before and in the first day, first week, 3 and 6 months after surgery to evaluate the pain. The results of time up and go test (TUG) were performed before and 2 weeks post surgery to evaluate the activity. The Oswestry dability index (ODI) was also used to judge the influence of surgery on the daily life of patients. Result First day, 1 week, 3 months and 6 months after surgery, the VAS scores of the two groups were significantly lower than that of preoperative (P<0.05). The VAS scores of TESSYS group were significantly lower than those of open surgery group at the first day after surgery (P=0.000). The results of TUG in the two groups were significantly lower than those in the 2 weeks after surgery (P<0.05), the TUG in TESSYS group was significantly lower than that in open surgery group (t=5.087,P=0.000). At 3, 6 and 12 months after surgery, the ODI scores of the two groups were significantly lower than those before surgery (P<0.05). The scores of ODI in TESSYS group were significantly lower than those in open surgery group at different time points (P<0.05). There were no complications such as dural rupture, vascular nerve injury and infection in the TESSYS group. In the open surgery group, 1 patient suffered from cauda equina injury, but the symptoms improved after treatment. However, there was still numbness in the sella region at the last follow-up. Conclusion Sequestered lumbar disc herniation combined with spinal canal stenosis can be more effectively treated by TESSYS technology in comparison with conventional surgery. For elderly patients, this technology has the benefits of optimal spinal stability, less postoperative complications and improved life quality.%目的 分析经皮椎间孔镜TESSYS技术治疗老年游离型腰椎间盘突出合并腰椎管狭窄症的临床效果.方法 选取2014年1月至2016年1月于本院接受经皮椎间孔镜TESSYS技术治疗的32例老年游离型腰椎间盘突出合并腰椎管狭窄症患者为研究对象(TESSYS组),以本院同期采用传统开放手术治疗的32例患者作为对照(开放手术组).分别于术前及术后1天、1周、3个月、6个月采用视觉模拟评分法(visual analogue scale,VAS)评价两组患者疼痛缓解程度,术前和术后2周采用起立-行走计时测试(time up and go test,TUG)评估两组患者行动能力,术前及术后3、6、12个月采用Oswestry功能障碍指数(Oswestry dability index,ODI)评估两组患者日常生活能力.结果术后第1天、1周、3个月及6个月两组患者VAS评分均显著低于本组术前(P<0.05),TESSYS组患者VAS评分均显著低于同期开放手术组(P=0.000).术后2周两组患者TUG结果均显著低于本组术前(P<0.05),TESSYS组患者TUG结果显著低于开放手术组(t=5.087,P=0.000).术后3、6及12个月,两组患者ODI评分较术前均显著降低(P<0.05),TESSYS组患者术后不同时间点ODI评分均显著低于开放手术组(P<0.05).TESSYS组无一例患者发生硬脊膜破裂、血管神经损伤、感染等并发症.开放手术组1例患者发生马尾神经损伤,经治疗后症状有所好转,但末次随访仍存在鞍区麻木.结论 经皮椎间孔镜TESSYS技术治疗老年游离型腰椎间盘突出合并腰椎管狭窄症,疗效显著优于传统开放手术,可有效维护患者脊柱稳定性,减少术后并发症,提高患者生活质量.
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