两种入路脊柱内镜椎管减压治疗单节段腰椎侧隐窝狭窄症  

Two kinds of percutaneous endoscopic lumbar decompression in the treatment of single level lumbar lateral recess stenosis

作　　者：陈康 罗圆超 杨富国 何仁建[1] CHEN Kang;LUO Yuan-chao;YANG Fu-guo;HE Ren-jian(Derpartment of Orthopaedics,the First People's Hospital of Zigong,Zigong 643000,Sichuan,China)

机构地区：[1]自贡市第一人民医院骨科,四川自贡643000

出　　处：《中国骨伤》2024年第4期338-344,共7页China Journal of Orthopaedics and Traumatology

基　　金：自贡市科学技术局重点科技计划项目(编号:2021YLSF01);四川医学会项目(编号:S20057)。

摘　　要：目的:探讨椎板间入路脊柱内镜腰椎管减压术(interlaminar percutaneous endoscopic lumbar decompression,IL-PELD)与椎间孔入路脊柱内镜腰椎管减压术(transforamenal percutaneous endoscopic lumbar decompression,TF-PELD)在单节段腰椎侧隐窝狭窄症的临床疗效。方法:自2018年4月至2021年7月采用脊椎内镜椎管减压术治疗85例单节段腰椎侧隐窝患者,其中男44例,女41例,年龄49~81(65.5±8.3)岁;病程3~83(26.7±16.5)个月。根据手术方式不同,分为IL-PELD组和TF-PELD组。其中IL-PELD组47例,男28例,女19例;年龄50~80(66.7±9.3)岁;病程3~65(25.7±15.0)个月。TF-PELD组38例,男16例,女22例;年龄51~78(64.1±7.6)岁;病程4~73(27.9±18.3)个月。记录两组手术时间、出血量、术中透视次数、住院时间及并发症等情况。于术前和术后1、6个月及末次随访时以疼痛视觉模拟评分(visual analogue scale,VAS)评估腰痛及下肢痛的程度、以Oswestry功能障碍指数(Oswestry disfunction index,ODI)评估腰椎功能。末次随访时以改良Macnab标准评估临床疗效。于术前和术后1周以侧隐窝矢状径评估责任椎间隙侧隐窝的减压程度。结果:两组均顺利完善手术,无血管损伤、硬膜囊撕裂、神经损伤等严重并发症。所有病例获得1年以上随访,时间14~53(27.0±9.4)个月。术后切口均Ⅰ期愈合,未发生椎间隙感染。IL-PELD组手术时间(69.3±19.3)min,多于TF-PELD组(57.5±14.5)min(P<0.05)。两组术中出血量比较差异无统计学意义(P>0.05)。TF-PELD组术中透视次数(8.8±2.6)次,多于IL-PELD组(4.8±1.2)次(P<0.05)。两组住院日比较差异无统计学意义(P>0.05)。IL-PELD组术前腰痛、下肢痛VAS及ODI分别为(5.1±2.2)、(6.9±1.3)分、(71.4±12.6)%,TF-PELD组分别为(4.7±1.8)、(6.9±1.3)分、(68.4±13.9)%。IL-PELD组术后1、6个月及末次随访腰痛VAS为(2.4±1.5)、(1.6±0.8)、(1.4±0.9)分,下肢痛VAS为(3.0±1.2)、(1.6±0.7)、(1.5±1.0)分,ODI为(32.6±11.9)%、(17.4±6.5)%、(19Objective To prospectively compare the clinical efficacy and radiographic outcomes between interlaminar percutaneous endoscopic lumbar decompression(IL-PELD)and transforaminar percutaneous endoscopic lumbar decompression(TF-PELD)in the treatment of single-segment lumbar lateral recess stenosis.Methods From April 2018 to July 2021,85 patients with single-segment lumbar lateral recess stenosis underment percutaneous endoscopic lumbar decompression.There were 44 males and 41 females,aged from 49 to 81 years old with an average of(65.5±8.3)years old,duration of lumbar lateral recess stenosis ranging from 3 to 83 months with an average of(26.7±16.5)months.They were divided into IL-PELD group and TF-PELD group according to the different operation methods.There were 47 patients in the IL-PELD group,including 28 males and 19 females aged from 50 to 80 yeaes old with an average age was(66.7±9.3)years old.The disease duration ranged from 3 to 65 months with an average of(25.7±15.0)months.There were 38 patients in the TF-PELD group,including 16 males and 22 females,aged from 51 to 78 years old with an average of(64.1±7.6)years old.The disease duration ranged from 4 to 73 months with an average of(27.9±18.3)months The operation time,intraoperative blood loss,intraoperative fluoroscopy,hospitalization day and complications of the two groups were recorded.Visual analogue scale(VAS)to evaluate low back pain and lower limb pain,Oswestry disability index(ODI)to evaluate lumbar function in preoperative and postoperative period(1month,6 months and last follow-up)were recorded.the sagittal diameter of the lateral recess of the responsible intervertebral space in preoperative and 1 week after the operation were recorded.Results The operation was successfully completed in both groups without serious complications such as vascular injury,dural sac tear and nerve injury.The operation time in IL-PED group(69.3±19.3)min was significantly longer than that in TF-PELD group(57.5±14.5)min(P<0.05).There was no significant difference in

关 键 词：腰椎 椎管狭窄 内窥镜检查 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]