脊柱内镜下可视化半环锯ULBD治疗对DLSS患者疼痛及腰椎功能的影响  

Affect of visual half ring saw for ULBD under spine endoscopy on pain and lumbar spine function in DLSS patients

作　　者：黄剑峰 眭金辉 尹保和 贺湘敏 陈杭才 邱波 陈合兰 蒋海军 HUANG Jian-feng;SUI Jin-hui;YIN Bao-he;HE Xiang-min;CHEN Hang-cai;QIU Bo;CHEN He-lan;JIANG Hai-jun(Department of Spinal Orthopedics,Hezhou Hospital of Traditional Chinese Medicine,Hezhou 542899,Guangxi,China)

机构地区：[1]贺州市中医医院脊柱骨科,广西贺州542899

出　　处：《川北医学院学报》2023年第6期768-772,共5页Journal of North Sichuan Medical College

基　　金：广西壮族自治区卫生健康委员会科研项目(Z-J20221798,Z-J20221799);广西壮族自治区贺州市科学研究与技术开发计划项目(贺科技2022114);广西壮族自治区中医药管理局科研项目(GXZYJ20220606)。

摘　　要：目的:探究脊柱内镜下可视化半环锯单侧入路双侧减压(ULBD)治疗对退行性腰椎管狭窄症(DLSS)患者腰椎疼痛及功能的影响。方法:按照手术方式不同将70例DLSS患者分为开放组(n=30)与内镜组(n=40)。开放组给予开放腰椎后路双侧椎板开窗椎管减压术治疗;内镜组给予脊柱内镜下可视化半环锯ULBD术治疗。比较两组患者临床疗效、围术期指标、疼痛程度、腰椎功能、病情情况及并发症发生情况。结果:两组患者临床优良率及手术时间比较,差异均无统计学意义(P>0.05)。内镜组出血量、卧床时间、术后住院时间均少于开放组(P<0.05),切口长度短于开放组(P<0.05)。与术前比较,两组患者术后3个月、1年的视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)评分均降低(P<0.05);日本骨科学会(JOA)评分均升高(P<0.05),但各评分两组间比较,差异均无统计学意义(P>0.05)。内镜组并发症总发生率低于开放组(P<0.05)。结论:脊柱内镜下可视化半环锯ULBD治疗DLSS的效果比开放手术显著,可加速患者术后康复、减轻疼痛感及促进腰椎功能恢复,且创伤较小、并发症较少。Objective:To analyze the affect of visual half ring saw for unilateral laminectomy for bilateral decompression(ULBD)under spine endoscopy on pain and lumbar spine function in patients with degenerative lumbar spinal stenosis(DLSS).Methods:70 DLSS patients were selected and divided into open surgical group(n=30)and endoscopic group(n=40)depending on the different surgery methods.Open posterior lumbar approach and bilateral fenestration of vertebral canal decompression was used of the open surgical group,and visual half ring saw for ULBD under spine endoscopy was used of the endoscopic group.The clinical efficacy,perioperative indexes,pain degree,lumbar spine function,illness state and incidence of complications were compared between the both groups.Results:The clinical excellent rate and surgical time between the both groups was apparently difference(P>0.05).The amount of blood loss,the time of lie in bed and preopertive hospitliztion in endoscopic group were shorter than those in open surgical group(P<0.05),and the incision length was shorter than that in open surgical group(P<0.05).Compared with before surgery,the visual analog scale(VAS)and Oswestry disability index(ODI)scores of both groups at 3 months and 1 year after surgery were decreased(P<0.05),the Japanese orthopaedic association(JOA)score was increased(P<0.05),and compared between the two groups,the difference was not statistically significant(P>0.05).The total incidence of complications in endoscopic group was lower than that in open surgical group(P<0.05).Conclusion:Visual half ring saw ULBD under spine endoscopy had significant effect in the therapy of DLSS patients,which had a better effect in accelerating the postoperative rehabilitation,alleviating the pain and promoting the recovery of lumbar spine function,with less trauma and fewer complications.

关 键 词：退行性腰椎管狭窄症 脊柱内镜 可视化半环锯 单侧入路双侧减压 疼痛 腰椎功能 

分 类 号：R681.5[医药卫生—骨科学] R687.4[医药卫生—外科学]