Delta大通道脊柱内镜手术减压治疗腰椎椎管狭窄症的有效性及安全性  

Effectiveness and Safety of Delta Large Channel Endoscopic Spinal Decompression in the Treatment of Lumbar Spinal Stenosis

作　　者：梁旭 吴建临 李雅君 赵艳东 王文革 LIANG Xu;WU Jianlin;LI Yajun(Linfen Central Hospital,Shanxi Linfen 041000,China)

机构地区：[1]山西省临汾市中心医院骨科,山西临汾041000

出　　处：《河北医学》2023年第6期983-989,共7页Hebei Medicine

基　　金：山西省卫生健康委科研课题计划项目,(编号:2020161)。

摘　　要：目的:探讨Delta大通道脊柱内镜手术减压治疗腰椎椎管狭窄症的临床效果。方法:本研究选取我院2021年1月至2022年1月收治的腰椎椎管狭窄症患者95例,其中48例患者采用Delta大通道脊柱内镜手术减压治疗(观察组)、另外47例患者采用单侧双通道脊柱内镜方式治疗(对照组),对比两组患者手术相关临床指标、手术前后的疼痛程度、Oswestry功能障碍指数(ODI)、椎管狭窄症CT影像学参数、临床疗效差异。结果:观察组患者手术时间短于对照组,手术出血量小于对照组,差异具有统计学意义(P<0.05);两组患者的术后下地时间、住院时间比较,差异无统计学意义(P>0.05);术前,观察组和对照组患者的腰部疼痛VAS评分、腿部疼痛VAS评分比较,差异无统计学意义(P>0.05);两组患者术后,腰部及腿部疼痛程度明显减轻,VAS评分与术前比较显著降低(P<0.05);术前,观察组和对照组患者的腰椎间隙椎管矢状径(Sagittal diameter of spinal canal,APDC)、椎管面积(Spinal canal area,CAC)、椎管内切圆面积(Area of vertebral canal,ICA)、硬膜囊面积(Dural sac area,CAD)和硬膜外间隙(Epidural space,LAC)测定值比较,差异均无统计学意义(P>0.05);两组患者术后3个月CT复查,显示患者的狭窄椎管得到很好的改善,腰椎间隙APDC、CAC、ICA、CAD、LAC测定值较本组术前显著的提高(P<0.05);术前,采用ODI对患者腰椎功能进行评价,观察组和对照组患者的ODI值差异均无统计学意义(P>0.05);两组患者术后腰椎功能得到明显的改善,ODI测定值较本组术前显著的降低(P<0.05);术后统计手术并发症,观察组为8.33%,对照组为4.26%,差异无统计学意义(P>0.05)。结论:Delta大通道脊柱内镜手术减压与单侧双通道脊柱内镜方式治疗腰椎椎管狭窄症均能取得良好的临床效果,但是前者的优势在于操作简单,所需手术时间及引起的手术出血量更少。Objective:To investigate the clinical effectiveness of Delta channel endoscopic spinal decompression in the treatment of lumbar spinal stenosis.Methods:A total of 95 patients with lumbar spinal stenosis admitted to our hospital from January 2021 to January 2022 were selected in this study.Among them,48 patients were treated with Delta channel spinal endoscopic surgical decompression(observation group),and the other 47 patients were treated with unilateral double-channel spinal endoscopic treatment(control group).The differences of surgery-related clinical indicators,pain degree before and after surgery,Oswestry disability index(ODI),CT imaging parameters of spinal stenosis,and clinical efficacy were compared between the two groups.Results:The operation time of the patients in the observation group was shorter than that in the control group,and the operation bleeding volume was less than that in the control group,the difference was statistically significant(P<0.05).There was no statistically significant difference between the two groups in the postoperative time to the ground and hospital stay(P>0.05).Before operation,there was no significant difference in VAS score of waist pain and VAS score of leg pain between the observation group and the control group(P>0.05).After operation,the pain degree of waist and leg in the two groups was significantly reduced,and the VAS score was significantly lower than that before operation(P<0.05).Before operation,there was no statistically significant difference in the measured values of sagittal diameter of spinal canal(APDC),spinal canal area(CAC),area of vertebral canal(ICA),dural sac area(CAD)and epidural space(LAC)between the observation group and the control group(P>0.05);three months after operation,CT reexamination of patients in both groups showed that the stenosis of the spinal canal of the patients was improved very well,and the measured values of APDC,CAC,ICA,CAD and LAC in the lumbar intervertebral space were significantly higher than those in the group before operat

关 键 词：Delta大通道 内镜手术 腰椎椎管狭窄症 OSWESTRY功能障碍指数 

分 类 号：R687.3[医药卫生—骨科学]