椎间孔镜双侧入路与大通道内镜下椎板间单侧入路双侧减压治疗重度中央型腰椎管狭窄症的对比研究  

A comparative study of bilateral access by PETD with unilateral access bilateral decompression by large channel endoscopy for severe central lumbar spinal stenosis

作　　者：胡源 孔清泉[2] 张斌[1] 冯品[1] 黄章恒 刘俊麟 马骏松 舒翔 HU Yuan;KONG Qing-quan;ZHANG Bin;FENG Pin;HUANG Zhang-heng;LIU Jun-lin;MA Jun-song;SHU Xiang(Department of Orthopedics,Tibetan Chengdu Office Branch Hospital of West China Hospital,Sichuan University,Chengdu,Sichuan,610041,China)

机构地区：[1]四川大学华西医院西藏成办分院骨科,成都610041 [2]四川大学华西医院骨科,成都610041

出　　处：《中国骨与关节杂志》2022年第6期422-429,共8页Chinese Journal of Bone and Joint

基　　金：西藏自治区科技计划项目(XZ201901-GB-08);四川省科技计划项目(2019YFQ0003);西藏自治区自然科学基金项目(XZ202101ZR0047G)。

摘　　要：目的 比较椎间孔镜双侧入路与大通道内镜下椎板间单侧入路双侧减压治疗重度中央型腰椎管狭窄症的疗效,为手术方式选择提供参考。方法 回顾性分析 2017 年 2 月至 2020 年 5 月,我院采用内镜手术治疗的 81 例单节段重度中央型腰椎管狭窄症伴双下肢症状患者的临床资料。其中 31 例采用了大通道内镜 (10 mm) 单侧入路双侧减压 (A 组),另外 50 例采用了椎间孔镜双侧入路 (7 mm) 双侧减压 (B 组)。比较两组患者性别构成比、年龄、手术减压时间、术中 C 型臂 X 线机透视次数、术后住院时间、手术效果及手术并发症。术前、术后 1 个月和末次随访时对下肢疼痛采用视觉模拟评分 (visual analogue scale,VAS),对腰椎功能采用 Oswestry 功能障碍指数 (oswestry disability index,ODI) 进行评价,末次随访根据改良 MacNab 评分标准评估手术疗效。结果 81 例均顺利实施手术,无神经损伤、中途转开放及椎间隙感染,A 组 1 例术后下肢麻木加重,B 组 1 例硬膜囊撕裂、2 例术后下肢麻木加重。81 例术后随访时间 13~25 个月,平均 (19.1±3.9) 个月,两组患者的性别、年龄、术前和随访期间 VAS 评分和 ODI 评分组间差异无统计学意义 (P > 0.05)。A 组与 B 组的手术时间[(84.5±18.5) min vs.(106.2±12.7) min,P=0.000]和透视次数[(7.4±1.9) 次 vs.(20.9±4.4) 次,P=0.000]差异有统计学意义。两组患者术后 1 个月、末次随访 VAS 评分以及 ODI 评分与术前相比明显降低 (P=0.000),两组患者术后住院时间差异无统计学意义 (P=0.168)。根据改良 MacNab 标准评定疗效:A 组优 22 例、良 8 例、可 1 例,优良率 96.8%;B 组优 35 例、良 13 例、可 2 例,优良率 96.0%。结论椎间孔镜双侧入路与大通道内镜下椎板间单侧入路双侧减压均是治疗重度中央型腰椎管狭窄症安全、有效、微创的手术方式,且临床疗效相近。但采用大通道内镜下椎板间单侧入路双�Objective To compare the efficacy of bilateral decompression by percutaneous endoscopic transforaminal discectomy with unilateral interlaminar approach with large channel endoscopic in the treatment of severe central lumbar spinal stenosis to further provide references for the selection of surgical methods.Methods A total of 81 patients with single-segment severe central lumbar spinal stenosis and bilateral lower extremity symptoms endoscopically treated at our hospital were retrospectively analyzed from February 2017 to May 2020.Among them,31 cases were treated with bilateral decompression by large channel endoscopy (10 mm) with unilateral access(group A),and the other 50 cases were treated with bilateral decompression by percutaneous endoscopic transforaminal discectomy (7 mm) (group B).The gender composition ratio,age,duration of surgical decompression,intraoperative C-arm fluoroscopy frequency,postoperative hospital stay,surgical outcome and complications were compared between the two groups.Visual analog scale (VAS) was used for lower extremity pain assessment before surgery,1 month after surgery and at the final follow-up.Oswestry Disability Index (ODI) was evaluated before surgery,1 month after surgery and at the final follow-up.Surgical efficacy was assessed at the final follow-up according to the modified MacNab scale.Results All 81 surgeries were completed successfully without nerve injury,mid-transfer opening or intervertebral space infection.One case in group A and two cases in group B developed aggravated postoperative lower limb numbness.Dural sac tear was observed in 1 case of group B.All patients were followed up for 13-25 months after surgery,with a mean of (19.1±3.9) months.Differences in gender,age,preoperative VAS,ODI and follow-up time between the two groups were not statistically significant (P > 0.05).Differences in operation time[(84.5±18.5) mins vs.(106.2±12.7) mins,P=0.000]and intraoperative C-arm fluoroscopy frequency[(7.4±1.9) vs.(20.9±4.4),P=0.000]between group A and B were stati

关 键 词：最小侵入性外科手术 脊柱 内窥镜 椎管狭窄 

分 类 号：R687.3[医药卫生—骨科学]