经皮全脊柱内镜下椎间孔入路和椎板间入路减压术治疗L_(5)-S_(1)侧隐窝狭窄的临床疗效比较  

Comparison of clinical efficacy of PEID and PETD in the treatment of L_(5)-S_(1) lateral recess stenosis

作　　者：李展奇 王贺 谢昌达 王辰超 王新虎[2] LI Zhanqi;WANG He;XIE Changda;WANG Chenchao;Wang Xinhu(Department of Orthopedics,Xi’an People’s Hospital/Xi’an Fourth Hospital,Xi’an 710005;Department of Spine Surgery,Baoji Center Hospital,Baoji 721008,China)

机构地区：[1]西安市人民医院/西安市第四医院骨科病院,陕西西安710005 [2]宝鸡市中心医院脊柱外科,陕西宝鸡721008

出　　处：《西安交通大学学报（医学版）》2022年第1期154-158,共5页Journal of Xi’an Jiaotong University（Medical Sciences）

摘　　要：目的比较经皮全脊柱内镜下椎间孔入路和椎板间入路减压术治疗腰5-骶1(L_(5)-S_(1))侧隐窝狭窄的临床疗效。方法选取2018年3月-2019年10月诊断为L_(5)-S_(1)侧隐窝狭窄症的患者,根据前瞻、单盲、随机对照原则分为A、B两组,A组患者接受经皮椎间孔入路内镜下减压术(PETD),B组患者经皮椎板间入路内镜下减压术(PEID),手术由本中心同一高年资、脊柱内镜技术成熟的外科医师完成。记录手术时间、C臂放射次数、住院天数、术前及术后3 d、1个月、1年及末次随访时的下肢VAS评分、ODI指数、末次随访时改良MacNab疗效。通过CT检查记录术前、术后1年骨性侧隐窝角度。结果共95例患者(A组:n=48;B组:n=47)符合条件均顺利完成手术并接受至少1年的随访,两组患者的手术时间及C臂放射次数差异有统计学意义(P<0.001),两组患者住院天数差异无统计学意义(P>0.05),两组患者术后3 d、1个月、1年及末次随访时的下肢VAS评分较术前明显改善(P<0.001)、两组患者术后3 d、1个月、1年及末次随访时ODI评分较术前明显改善(P<0.001),但两组间同时间点比较无统计学差异(P>0.05);两组在末次随访时的手术优良率差异无统计学意义(P>0.05)。两组患者术后1年随访骨性侧隐窝角度较术前明显改善(P<0.05),但组间比较无统计学意义(P>0.05)。结论PEID与PETD是治疗L_(5)-S_(1)侧隐窝狭窄症的有效手术方式,且均可达到良好的临床效果。Objective To compare the clinical efficacy of percutaneous transforaminal endoscopic decompression(PEID)and percutaneous interlaminar endoscopic decompression(PETD)in the treatment of L_(5)-S_(1) lateral recess stenosis.Methods We selected the patients in our center diagnosed with L_(5)-S_(1) lateral recess stenosis from March 2018 to October 2019 and divided them into Group A and Group B according to the principle of prospective,single-blind,and randomized control(A:PETD;B:PEID).The operation was performed by the same senior surgeon with mature spinal endoscopy technology.We recorded the basic information,operation duration,usage count of C-arm,hospital stay,VAS score and ODI index of lower back and lower limbs before operation and 3 days,1 month,1 year and the last follow-up after the operation,and the operative excellent and good rates(the last follow-up).The angle of bony lateral recess was measured during pre-and postoperative CT.Results A total of 95 patients(A:n=48;B:n=47)successfully completed the operation and were followed up for at least 1 year.The two groups did not significantly differ in age,gender,hospital stay,or complication by lumbar intervertebral disc herniation,but PEID group had significantly shorter operation duration and fewer usage counts of C-arm(P<0.001).VAS score of lower back and lower limbs,and ODI index were significantly reduced at 3 days,1 month,1 year and the last follow-up after the operation,with no significant difference between the two groups at the same time;no statistical difference was found between the two groups in operative excellent and good rates at the last follow-up(P>0.05).The postoperative bony side recess angle was significantly improved(P<0.05),while there was no significant difference in either pre-or postoperative bony side recess angle between the two groups(P>0.05).Conclusion Both PEID and PETD are effective strategies in the treatment of L_(5)-S_(1) lateral recess stenosis and can achieve good clinical outcomes.

关 键 词：经皮全脊柱内镜 椎间孔入路 椎板间入路 腰5-骶1侧隐窝狭窄 

分 类 号：R681.5[医药卫生—骨科学]