全可视脊柱内镜下不同入路选择性减压术在腰椎管狭窄症中的应用  

Application of Selective Decompression with Different Approaches Under Full Visual Spinal Endoscopy in Lumbar Spinal Stenosis

作　　者：郑辉 ZHENG Hui(Department of Spine,Zhoukou Orthopedic Hospital,Zhoukou 466000,China)

机构地区：[1]周口骨科医院神经脊柱外科,河南周口466000

出　　处：《河南医学研究》2024年第3期496-499,共4页Henan Medical Research

摘　　要：目的 比较全可视脊柱内镜下不同入路选择性减压术在腰椎管狭窄症中的应用效果。方法 回顾性收集2020年2月至2022年6月于周口骨科医院行全可视脊柱内镜下减压术的88例腰椎管狭窄症患者的临床资料,根据入路方式将经侧方入路的患者资料纳入侧方组(40例),将经椎板间入路的患者资料纳入椎板间组(48例),所有患者术后均完成6个月随访。比较两组手术时间、术中出血量、术后首次下床时间;比较两组术前、术后3个月、术后6个月时腰椎功能[改良版Oswestry功能障碍指数(ODI)];比较两组术后1、3、6个月时疼痛程度[视觉模拟评分法(VAS)];并比较两组术后并发症发生情况。结果 两组术中出血量比较,差异无统计学意义(P>0.05);椎板间组手术时间短于侧方组,术后首次下床时间长于侧方组,差异有统计学意义(P<0.05)。两组手术前后ODI指数的变化幅度不同,椎板间组变化更明显;两组术后3、6个月ODI指数均低于术前(P<0.05),术后6个月ODI指数低于术后3个月(P<0.05)。两组术后VAS评分的变化幅度不同,椎板间组变化更明显;两组术后3、6个月VAS评分均低于术后1个月(P<0.05),术后6个月VAS评分低于术后3个月(P<0.05)。两组术后并发症总发生率比较,差异无统计学意义(P>0.05)。结论 全可视脊柱内镜下经侧方及经椎板间入路选择性减压术应用于腰椎管狭窄症中均可取得较好效果,且具有一定安全性,但经椎板间入路可缩短手术时间,且患者术后腰椎功能及疼痛程度的改善更为显著。Objective To compare the application effect of selective decompression with different approaches under full visual spinal endoscope in lumbar spinal stenosis.Methods The clinical data of 88 patients with lumbar spinal stenosis who underwent full visual spinal endoscopic decompression in Zhoukou Orthopedic Hospital from February 2020 to June 2022 were retrospectively collected.According to different approaches,the patient data from the lateral approach were included in the lateral group(40 cases),and the patient data from the intervertebral disc approach were included in the inter-laminar group(48 cases).All patients were followed up for 6 months after operation.The operation time,intraoperative blood loss and the first time of getting out of bed after operation were compared between the two groups.The lumbar function of the two groups before operation,3 months after operation and 6 months after operation[modified oswestry dysfunction index(ODI)]was compared.The pain degree[visual analogue scale(VAS)]was compared between the two groups at 1,3 and 6 months after operation.The postoperative complications of the two groups were compared.Results There was no statistical significant difference in the amount of intraoperative bleeding between the two groups(P>0.05).The operation time in the inter-laminar group was shorter than that in the lateral group,and the first time of getting out of bed after operation was longer than that in the lateral group,and the difference was statistically significant(P<0.05).The variation amplitude of ODI index before and after operation was different between the two groups,and the change was more obvious in the inter-laminar group.The ODI index at 3 and 6 months after surgery was lower than that before surgery(P<0.05),and the ODI index at 6 months after surgery was lower than that at 3 months after surgery(P<0.05).The VAS score of the two groups was different,and the change of the inter-laminar group was more obvious.The VAS score at 3 and 6 months after surgery was lower than that at 1 m

关 键 词：腰椎管狭窄症 选择性减压术 全可视脊柱内镜 经侧方入路 经椎板间入路 

分 类 号：R687.3[医药卫生—骨科学]