内镜与开放双侧减压治疗老年腰椎管狭窄症  

Endoscopic versus open bilateral decompression for lumbar spinal stenosis in elderly

作　　者：汤玮 丁兆利 潘伟 韩庆龙 周东生[2] TANG Wei;DING Zhao-li;PAN Wei;HAN Qing-long;ZHOU Dong-sheng(Department of Orthopedics,The Second People's Hospital of Rizhao City,Rizhao,Shandong 276807,China;Department of Orthopaedics,Shandong Provincial Hospital,Jinan,Shandong 250000,China)

机构地区：[1]日照市第二人民医院骨科,山东日照276807 [2]山东省立医院骨科,山东济南250000

出　　处：《中国矫形外科杂志》2024年第16期1520-1524,共5页Orthopedic Journal of China

摘　　要：[目的]比较Endo-Surgi Plus脊柱内镜单侧入路双侧减压技术(endoscopic unilateral laminotomy and bilateral decompression,Endo-ULBD)与开放双侧减压治疗老年腰椎管狭窄症患者的临床疗效。[方法]2018年12月—2020年12月在本院手术治疗的51例腰椎管狭窄症患者纳入本研究,根据医患沟通结果,将患者分为内镜组(31例),开放组(20例)。比较两组临床和影像结果。[结果]所有患者均顺利完成手术,内镜组手术时间[(73.2±21.0)min vs(178.4±22.9)min,P<0.001]、术中出血量[(7.1±3.6)ml vs(220.0±140.9)ml,P<0.001]、术后下地时间[(1.5±0.4)d vs(6.4±1.8)d,P<0.001]、住院时间[(3.0±1.2)d vs(9.4±3.1)d,P<0.001]均显著少于开放组。随时间推移,两组腰痛、腿痛VAS评分、ODI评分均显著改善(P<0.05),相应时间点,两组间上述指标的差异均无统计学意义(P>0.05)。末次随访两组MacNab优良率的差异无统计学意义(P>0.05)。与术前相比,末次随访时,两组椎间隙高度无显著变化(P>0.05),硬膜囊横截面积显著增加(P<0.05)。相应时间点,两组间上述影像指标的差异均无统计学意义(P>0.05)。[结论]Endo-ULBD治疗老年腰椎管狭窄症,具有安全、微创、康复快等优点,且疗效与开放手术相当,短期临床疗效好。[Objective]To compare the clinical outcomes of endoscopic unilateral laminotomy and bilateral decompression(EndoULBD)with Endo-Surgi Plus endoscope versus open bilateral decompression for lumbar spinal stenosis in the elderly.[Methods]A retrospective study was done on 51 patients who received surgical treatment for lumbar spinal stenosis in our hospital from December 2018 to December 2020.According to the doctor-patient communication,31 patients underwent the endoscopic decompression,while other 20 patients had the conventional open decompression.The clinical and imaging data were compared between the two groups.[Results]All patients in both groups had operation performed successfully.The endoscopic group was significantly superior to the open group in terms of operation time[(73.2±21.0)min vs(178.4±22.9)min,P<0.001],intraoperative blood loss[(7.1±3.6)ml vs(220.0±140.9)ml,P<0.001],postoperative bed rest time[(1.5±0.4)days vs(6.4±1.8)days,P<0.001],and hospital stay[(3.0±1.2)days vs(9.4±3.1)days,P<0.001].As time went by,the VAS scores of low back pain and leg pain,as well as ODI score in the two groups were significantly improved(P<0.05),which were not statistically significant between the two groups at any corresponding time points(P>0.05).At the last follow-up,there was no significant difference in MacNab excellent and good rate between the two groups(P>0.05).At the last follow-up,there was no significant change in vertebral space height(P>0.05),while the dural sac cross-sectional area was significantly increased in both groups compared with those before operation(P<0.05).At corresponding time points,there were no significant differences in the above image indicators between the two groups(P>0.05).[Conclusion]The Endo-ULBD achieve good short-term clinical consequence comparable to the open surgery,while has the advantages of minimally invasive surgery and rapid recovery for lumbar spinal stenosis in the elderly.

关 键 词：Endo-Surgi Plus脊柱内镜单侧入路双侧减压技术(Endo-ULBD) 腰椎管狭窄症 可视化环锯 

分 类 号：R681.5[医药卫生—骨科学]