开放手术与脊柱内镜下行椎板减压治疗退变性腰椎管狭窄症的临床对照研究  

Comparison of outcomes between open surgery and spinal endoscopic laminectomy in lumbar spinal stenosis

作　　者：孙凤龙[1] 李军 梁庆晨 王宏庆 刘祖耀[1] 李富[1] 董婕[1] 刁文博 闫明[3] SUN Fenglong;LI Jun;LIANG Qingchen;WANG Hongqing;LIU Zhuyao;LI Fu;DONG Jie;DIAO Wenbo;YAN Ming(Department of Orthopedics,Beijing Rehabilitation Hospital Affiliated to Capital Medical University,Beijing 100043;Department of Orthopedics,Zhoukou Union Osteological Hospital,Zhoukou 466000,Henan;Department of spinal surgery,First Hospital of Bethune,Jilin University,Changchun 130021,China)

机构地区：[1]首都医科大学附属北京康复医院骨二科,北京100043 [2]周口协和骨科医院骨科,河南周口466000 [3]吉林大学白求恩第一医院脊柱外科,长春130021

出　　处：《中华骨与关节外科杂志》2018年第11期805-811,共7页Chinese Journal of Bone and Joint Surgery

摘　　要：背景:退变性腰椎管狭窄症的发生率逐年增加,如何有效使用脊柱内镜技术优势进行椎板减压治疗是目前研究的方向。目的:探讨脊柱内镜下行椎板减压手术治疗退变性腰椎管狭窄症患者的临床效果。方法:回顾性分析2016年1月至2017年7月采用手术治疗的单节段退变性腰椎管狭窄症患者78例,其中32例行传统半椎板切除减压手术为开放组,46例行脊柱内镜下椎板减压手术为内镜组,比较两组患者的临床疗效。结果:内镜组在手术时间、手术出血、切口长度、卧床时间及住院时间方面均优于开放组,差异具有统计学意义(P<0.05)。两组患者术前、术后3个月、术后6个月、术后1年及末次随访时的JOA和ODI评分比较均未见统计学差异(P>0.05);而两组术后1个月的JOA和ODI评分比较,均具有统计学差异(P<0.05)。结论:脊柱内镜下椎板减压治疗腰椎椎管狭窄症,相比于传统半椎板切开减压术具有时间短、创伤小、恢复快等特点,能够满足减压要求基础上,对腰椎稳定性破坏较少,更有效的保留了腰椎功能。Background:The incidence of lumbar spinal stenosis is increasing.How to effectively use spinal endoscopic technique to treat lumbar spinal stenosis is the direction of our research.Objective:To explore the clinical effect of endoscopic laminectomy in the treatment of lumbar spinal stenosis.Methods:From January 2016 to July 2017,78 patients with lumbar spinal stenosis underwent surgery.According to the wishes of patients,32 patients were divided into open surgical group,and endoscopic group 46 cases.The clinical effects of the two groups were compared.Results:There were significant differences in operative time,operative bleeding,incision length,bedridden time and hospitalization time between the two groups (P<0.05).As for the JOA and ODI score of patients in the two groups,there was no statistically significant in the preoperative,3 months after operation,6 months after operation,1 years after operation and last follow-up (P >0.05).There was a statistically significant difference in the ODI score and JOA between the two groups at 1 months after operation (P<0.05).Conclusions: Spinal endoscopic laminectomy in the treatment of lumbar spinal stenosis is characterized by shorter time,less trauma and faster recovery than the traditional semi laminectomy and decompression.It can meet the requirements of decompression and reduce the stability of lumbar spine less and effectively restore the function of the lumbar spine.

关 键 词：腰椎 椎管狭窄 内窥镜 椎板切除术 

分 类 号：R687.3[医药卫生—骨科学]