脊柱内镜下椎板切开减压术治疗腰椎管狭窄症伴退变性滑脱的中长期疗效观察  

Long-term efficacy of spinal endoscopic laminectomy decompression in the treatment of lumbar spinal stenosis with degenerative spondylolisthesis

作　　者：田水净 李健辉[1] 韩林荟 王梦瑶[1] 景邵春[1] TIAN Shui-jing;LI Jian-hui;HAN Lin-hui(Department of Orthopedics,The Second Hospital of Qinhuangdao,Qinhuangdao 066600,China)

机构地区：[1]秦皇岛市第二医院骨科,河北秦皇岛066600

出　　处：《临床和实验医学杂志》2025年第2期168-172,共5页Journal of Clinical and Experimental Medicine

基　　金：秦皇岛市科技计划项目(编号:202301A155);河北省高层次人才资助项目(编号:C20231079)。

摘　　要：目的观察脊柱内镜下椎板切开减压术治疗腰椎管狭窄症伴退变性滑脱的中长期疗效。方法回顾性选择2021年9月至2024年6月秦皇岛市第二医院手术治疗的106例腰椎管狭窄症合并退变性滑脱患者作为研究对象。以手术方案不同分为观察组(n=53)和对照组(n=53)。观察组患者给予脊柱内镜下椎板切开减压术治疗,对照组患者给予开窗减压术治疗。比较两组患者的手术与康复指标(手术时间、术中出血量、术后卧床及住院时间),中远期疗效,术前、术后3个月以及术后6个月的疼痛[视觉模拟评分法(VAS)评分]、腰椎功能[Oswestry功能障碍指数(ODI指数)]以及并发症发生情况。结果观察组患者手术时间、术中出血量、术后卧床时间及住院时间分别为(69.75±8.33)min、(64.48±7.22)mL、(27.45±5.46)h、(5.22±1.21)d,均明显低于对照组[(95.16±9.73)min、(116.38±11.29)mL、(43.76±5.51)h、(8.96±1.39)d],差异均有统计学意义(P<0.05)。观察组患者术后6个月的治疗优良率为90.56%,明显高于对照组(64.15%),差异有统计学意义(P<0.05)。术后3、6个月,两组患者的VAS评分与ODI指数均较术前明显降低,差异均有统计学意义(P<0.05);观察组患者术后3个月的VAS评分及术后3、6个月的ODI指数分别为(2.16±0.41)、(21.66±4.96)、(12.18±3.24)分,均明显低于对照组[(3.21±0.54)、(26.15±5.58)、(14.56±2.93)分],差异均有统计学意义(P<0.05);观察组患者术后6个月的VAS评分与对照组比较,差异无统计学意义(P>0.05)。观察组患者术后总并发症发生率为1.88%,明显低于对照组(11.32%),差异有统计学意义(P<0.05)。结论脊柱内镜下椎板切开减压术对腰椎管狭窄症伴退变性滑脱的中远期疗效肯定,手术伤害小且康复较快,术后中期的脊椎功能与疼痛缓解效果更好,安全性较为理想,较开放性术式的微创性明显,更符合人性化与科学化的治疗要求。Objective To observe the medium and long term efficacy of spinal endoscopic laminectomy decompression in the treatment of lumbar spinal stenosis with degenerative spondylolisthesis.Methods A total of 106 patients with lumbar spinal stenosis complicated with degenerative spondylolisthesis who underwent surgical treatment in the Second Hospital of Qinhuangdao from September 2021 to June 2024 were retrospectively selected as the study subjects.They were divided into the observation group(n=53)and the control group(n=53)according to the different surgical schemes.The patients in the observation group were treated with spinal endoscopic laminectomy decompression,and the patients in the control group were treated with fenestration decompression.The operation and rehabilitation indexes(operation time,intraoperative blood loss,postoperative bed rest and hospitalization time),mid-term and long-term efficacy,pain[visual analogue scale(VAS)score],lumbar function[Oswestry dysfunction index(ODI index)]before operation,3 months and 6 months after operation and complications were compared between the two groups.Results The operation time,intraoperative blood loss,postoperative bed rest and hospitalization time in the observation group were(69.75±8.33)min,(64.48±7.22)mL,(27.45±5.46)h and(5.22±1.21)d,respectively,which were significantly lower than those of the control group[(95.16±9.73)min,(116.38±11.29)mL,(43.76±5.51)h,(8.96±1.39)d],and the differences were statistically significant(P<0.05).The excellent and good rate of treatment at 6 months after operation in the observation group was 90.56%,which was significantly higher than that in the control group(64.15%),and the difference was statistically significant(P<0.05).At 3 and 6 months after operation,the VAS score and ODI index of the two groups were significantly lower than those before operation,and the differences were statistically significant(P<0.05).The VAS score at 3 months after operation and ODI index at 3 and 6 months after operation in the observation group

关 键 词：腰椎管狭窄症 退变性滑脱 脊柱内镜下椎板切开减压术 中长期疗效 

分 类 号：R68[医药卫生—骨科学]