全可视化内镜椎间孔成形改良经椎孔内窥镜脊柱系统技术治疗单节段腰椎间盘突出症及腰椎管狭窄症短期临床效果观察  

Short-term clinical observation on the treatment of single-segment lumbar disc herniation and lumbar spinal stenosis by improved transforaminal endoscopic spine system technique with full visual endoscopic foraminoplasty

作　　者：刘志强[1] 焦顺成[1] 王振堂[1] Liu Zhiqiang;Jiao Shuncheng;Wang Zhentang(Department of Spinal Surgery,Shunyi Hospital,Beijing 101300,China)

机构地区：[1]北京市顺义区医院脊柱外科,北京101300

出　　处：《中国综合临床》2022年第4期351-357,共7页Clinical Medicine of China

摘　　要：目的探讨应用全可视化椎间孔成形经皮椎间孔镜椎间盘切除术(percutaneous transforaminal endoscopic discectomy,PTED)改良经皮椎间孔镜(transforaminal endoscopic spine system,TESSYS)技术治疗腰椎间盘突出症及腰椎管狭窄症的安全性及疗效。方法采用病例对照研究方法,分析2020年4月至2021年3月应用可视化内镜椎间孔成形改良TESSYS技术及经椎间孔椎间融合术(transforminal lumbar interbody fusion,TLIF)治疗的68例单节段腰椎间盘突出症及腰椎管狭窄症患者的临床资料。根据手术方式分为椎间孔镜(PTED)组38例及TLIF组30例。采用独立样本t检验比较两组手术切口长度、出血量、手术时间、下地时间、住院时间。视觉模拟量表(visual analogue scale,VAS)评分、Oswestry功能障碍指数(Oswestry disability index,ODI)评分采用重复测量的计量资料采用广义估计方程分析比较手术前与术后7天及术后1、3、6个月的差异,并结合末次随访改良MacNab标准进行等级资料行秩和检验检验;优良率组间比较采用χ^(2)检验评定疗效。结果术后随访8.5~14.0个月。PTED组的切口长度(1.25±0.33)cm、手术时间(119.45±14.95)min、出血量(24.03±8.62)mL、下地时间(1.42±0.50)d、住院时间(3.39±0.55)d均较TLIF组[(14.37±2.91)cm、(140.53±16.16)min、(158.00±51.35)mL、(3.20±0.96)d、(7.33±0.55)d]占有明显的优势(t值分别为24.56、5.57、14.13、9.20、29.48,均P<0.001)。两组患者术后VAS评分及ODI评分较术前均得到明显改善(均P<0.001),且随着时间的推移,两组患者术后7 d~6个月的VAS评分及ODI评分均显著降低(P<0.001);但两组间在术后1周~6个月的VAS评分(P_(7d)=0.997,P_(1月)=0.139,P_(3月)=0.057,P_(6月)=0.539)及ODI评分(P_(7d)=0.278,P_(1月)=0.442,P_(3月)=0.963,P_(6月)=0.278)在各时间点差异无统计学意义。末次随访经改良MacNab标准评价临床疗效及优良率方面两组比较差异无统计学意义(Z=0.09,P=0.927;χ^(2)=0.92,P=0.761)�Objective To investigate the safety and efficacy of the modified transcutaneous endoscopic spine system(TESSYS)with full visual foramen plasty and percutaneous endoscopic discectomy(PTED)in the treatment of lumbar disc herniation and lumbar spinal stenosis.Methods A case-control study was conducted to analyze the clinical data of 68 patients with single segment lumbar disc herniation and lumbar spinal stenosis treated with visual endoscopic foraminal plasty and modified TESSYS technique and intervertebral foraminal fusion from April 2020 to March 2021.According to the operation method,38 cases were divided into two groups:pted group(38 cases)and TLIF group(30 cases).Independent sample t-test was used to compare the incision length,bleeding volume,operation time,time to go down and hospital stay between the two groups.Visual analog scale(VAS)scores and Oswestry disability index(ODI)scores were measured repeatedly.The differences between preoperative and postoperative 7 days and 1,3,6 months were analyzed and compared by generalized estimation equation.Rank sum test was performed in combination with the modified MacNab standard in the last follow-up.The excellent and good rate was compared between groups χ^(2).Test and evaluate the curative effect.Results The postoperative follow-up was 8.5-14.0 months.The incision length(1.25±0.33)cm,operation time(119.45±14.95),blood loss(24.03±8.62)mL,downtime time(1.42±0.50)d,and hospital stay(3.39±0.55)d in the PTED group were all higher than those in the TLIF group((14.37±2.91)cm,(140.53±16.16)min,(158.00±51.35)mL,(3.20±0.96)d,(7.33±0.55)d)had obvious advantages(t values were 24.56,5.57,14.13,9.20,and 29.48,respectively;all P<0.001).The VAS scores and ODI scores of the two groups after operation were significantly improved compared with those before operation(all P<0.001),and with the passage of time,the VAS scores and ODI scores of the two groups of patients from 7 days to 6 months after operation by month were significantly decreased(P<0.001).However,there was no

关 键 词：腰椎间盘突出症 腰椎管狭窄症 椎间孔镜技术 可视化椎间孔成形 

分 类 号：R687.3[医药卫生—骨科学]