新型经椎间孔入路经皮内窥镜手术治疗伴基础疾病的腰椎退行性疾病  

New type percutaneous transforaminal endoscopic surgery for lumbar degenerative diseases with underlying diseases

作　　者：贾瑞平 马添乐 顾宇彤 连小峰[4] 许国华 Jia Ruiping;Ma Tianle;Gu Yutong;Lian Xiaofeng;Xu Guohua(Department of Orthopeaedics,East Ward of Xinxiang Central Hospital,Fourth Clinical Collage of Xinxiang Medical Collage,Xinxiang 453000,Henan,China;Department of Orthopaedics,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Shanghai Southwest Spine Surgery Center,Shanghai 200032,China;Department of Orthopaedics,Sixth People's Hospital,Shanghai 200233,China;Department of Orthopaedics,Changzheng Hospital,Naval Medical University,Shanghai 200003,China)

机构地区：[1]新乡市中心医院(新乡医学院第四临床学院)东区骨科,新乡4530002 [2]复旦大学附属中山医院骨科,上海2000323 [3]沪西南脊柱外科中心,上海2000324 [4]上海市第六人民医院骨科,上海2002335 [5]海军军医大学长征医院骨科,上海200003

出　　处：《脊柱外科杂志》2024年第5期295-301,共7页Journal of Spinal Surgery

基　　金：上海市“科技创新行动计划”技术标准项目(23DZ2201900)。

摘　　要：目的评估新型经椎间孔入路经皮内窥镜手术(PTES)治疗伴基础疾病的腰椎退行性疾病(LDD)的疗效、安全性及可行性。方法回顾性分析2017年6月—2019年4月复旦大学附属中山医院采用新型PTES治疗并获得2年以上随访的196例单节段LDD患者临床资料,其中89例伴基础疾病(A组),107例不伴基础疾病(B组)。记录2组手术时间、切口长度、术中透视次数、术中出血量、住院时间及并发症发生情况。于术前,术后即刻,术后1、2、3、6、12个月及末次随访时采用疼痛视觉模拟量表(VAS)评分评估患者下肢疼痛程度;术前、末次随访时采用Oswestry功能障碍指数(ODI)评估腰椎功能情况;末次随访时采用改良MacNab标准评估疗效。结果所有手术顺利完成。2组手术时间、切口长度、术中透视次数、术中出血量、住院时间差异均无统计学意义(P>0.05)。2组术后即刻下肢痛VAS评分较术前明显改善,且在术后1、2、3、6、12个月及末次随访时较术后即刻进一步改善,差异均有统计学意义(P<0.05)。2组末次随访时ODI较术前明显改善,差异有统计学意义(P<0.05)。组间术后各时间点VAS评分和ODI差异均无统计学意义(P>0.05)。根据改良MacNab标准,末次随访时2组疗效优良率差异无统计学意义(P>0.05)。2组并发症发生率差异无统计学意义(P>0.05)。2组均未发生伤口感染、永久性神经损伤、腹部器官损伤、大血管破裂等并发症。结论新型PTES治疗伴基础疾病的LDD安全、有效、微创,值得临床推广。Objective To evaluate the efficacy,safety and feasibility of the new type percutaneous transforaminal endoscopic surgery(PTES)for the treatment of lumbar degenerative diseases(LDD)with underlying diseases.Methods From June 2017 to April 2019,the data of 196 patients with single-segment LDD treated by the new type PTES and followed up for more than 2 years in Zhongshan Hospital Affiliated to Fudan University were retrospectively analyzed,including 89 patients with underlying diseases(group A)and 107 without underlying diseases(group B).Operation time,incision length,intraoperative fluoroscopy frequency,intraoperative blood loss,hospital stay and complications were recorded in the 2 groups.The intensity of lower limb pain was assessed by the visual analogue scale(VAS)score at pre-operation,immediate post-operation,postoperative 1,2,3,6,12 months and the final follow-up;and the Oswestry disability index(ODI)was used to assess the lumbar spine function at pre-operation and the final follow-up;and the clinical efficacy was evaluated by the modified MacNab criteria at the final follow-up.Results All the operations were successfully completed.There was no significant difference in operation time,incision length,intraoperative fluoroscopy frequency,intraoperative blood loss and hospital stay between the 2 groups(P>0.05).The VAS score of lower limb pain of the 2 groups was significantly improved at immediate post-operation,and further improvement was observed at postoperative 1,2,3,6,12 months and at the final follow-up,all with a statistical significance(P<0.05).The ODI of the 2 groups was significantly improved at the final follow-up,and the difference was statistically significant(P<0.05).There was no significant difference in VAS score and ODI between the 2 groups at each time point after surgery(P>0.05).According to the modified MacNab criteria,there was no significant difference in the excellent and good rate between the 2 groups at the final follow-up(P>0.05).There was no significant difference in the incidence of

关 键 词：腰椎 椎间盘退行性变 椎管狭窄 内窥镜检查 外科手术 微创性 

分 类 号：R681.533.1[医药卫生—骨科学]