摘要
目的:比较显微内窥镜与显微镜下手术治疗腰椎管狭窄症的疗效。方法:回顾性分析2003年1月至2008年1月因腰椎管狭窄症采用显微内窥镜(A组,97例)与显微镜下手术治疗病例(B组,95例)。比较两组患者在手术时间、术中情况、疗效、并发症及腰椎稳定性等方面的指标。术前及术后8个月时应用ODI(Oswestry disability index)评分法对患者进行评定,并进行综合满意度评估。结果:A组中7例术中转为开放手术,其余两组病例均顺利完成手术。手术时间A组平均82.2±5.2min,B组平均80.2±4.3min;术中出血A组平均83.1±4.1ml,B组平均80.0±6.7ml,两组间差异均无统计学意义(P>0.05)。两组术中各有3例患者发生硬脊膜破裂,予以修补,填塞压迫等相应处理后痊愈,术后无神经根损伤、感染等并发症。A组术中转开放手术者术后4年发生腰椎失稳2例,经腰椎间融合联合椎弓根螺钉内固定术治愈。两组均获得8个月以上随访,A组ODI评分术前平均79.2±15.4分,术后8个月时平均31.2±13.3分;B组术前平均78.7±16.9分,术后8个月时平均30.1±15.3分。两组手术前后ODI评分差异均有统计学意义(P<0.05);两组之间差异无统计学意义(P>0.05)。手术综合满意程度评估,A组优68例,良15例,可7例,优良率92.2%;B组优74例,良15例,可6例,优良率93.7%,两组间差异无统计学意义(P>0.05)。结论:显微内窥镜与显微镜下手术治疗腰椎管狭窄症疗效满意,均具有创伤小、出血少、并发症少、对腰椎后柱结构破坏小等优点。
Objective：To compare the surgical outcome of microendoscope and microscope assisted decompression for lumbar vertebral canal stenosis.Method：A retrospective study was carried out on 192 patients with lumbar vertebral canal stenosis treated by either microendoscope or microscope assisted decompression from January 2003 to January 2008.A11 patients were divided into two groups with 97 cases in group A and 95 cases in group B.The operate time ,intraoperative blood loss ,complication and the stability of lumbar spine after operation were compared between two groups,all patients were evaluated by ODI （Oswestry disability index） before operation and 8 months after operation as well as the general satisfactoty degree.Result：7 cases in group A were turned to open operation,except for these,all cases had been successfully operated.The mean operating time in group A was 82.2±5.2 minutes,and 80.2±4.3 minutes in group B.The average blood loss volumn in group A was 83.1±4.1ml,and 80.0±6.7ml in group B,whieh had no statistical significance（P〉0.05）. 3 cases were complicated with dural sac rupture in both two groups,which healed after corresponding treatment.There was no neurological complications and deep infection.2 cases in group A developed spinal instability 4 years after operation,which was resolved by PLIF.No significant deviation was found between two groups （P〈0.05）.All eases were followed up at least 8 months.Pre- and post-operative ODI score were 79.2± 15.4 and 31.2±13.3 respectively in group A,and 78.7±16.9 and 30.1±15.3 respectively in group B,which showed significant differences in pre- and post-operation ODI score of each group （P〈0.05）,however no significant differences were noted between two groups （P〈O.05）.Satisfactory rate in group A was excellent in 68 cases,good in 17 cases,fair in 7 cases and no poor,with the excellent and good rate of 92.2%.While in group B there was excellent in 74 cases,good in 15 cases,fair in 6 cases and no poor with the excellent and good rate of 93.7%.There was no significant differences between two groups （P〈0.05）.Conclusion：The clinical outcome of two minimal invasive surgery are satisfactory,which had advantages of minimal incision, less blood loss,shorteness of operation time,less complications and less damage to posterior column of lumbar spine.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
北大核心
2009年第9期671-675,共5页
Chinese Journal of Spine and Spinal Cord
关键词
腰椎管狭窄症
显微内窥镜
显微镜
微创
疗效
Lumbar vertebral canal stenosis
Microendoscope
Microscope
Minimally invasive
Curative effect
