摘要
目的探讨内镜下二次椎间孔成形技术在腰椎管狭窄症中的临床疗效。方法选取我院68例腰椎管狭窄症患者,随机分为内镜组(观察组)和传统术式组(对照组),各34例,并随访6~24个月,观察两组手术并发症、手术时间、术中出血量、住院时间、住院费用及手术效果,以评估观察组的临床疗效。结果两组平均随访16个月,性别、年龄、术前VAS评分差异无统计学意义(P>0.05),观察组较对照组手术时间短、术中出血少、住院时间短、住院费用少,差异有统计学意义(P<0.05);术后1周、1、6个月及末次随访,两组患者1个月内VAS及ODI评分差异有统计学意义(P<0.05),6月后差异无统计学意义(P>0.05),并使用改良的MacNab标准评价术后1年患者的疗效差异无统计学意义(P>0.05)。观察时间内观察组有2例1年内症状反复,为中央管狭窄患者,二期开放手术后症状消失,1例术中出现脊髓高压症,经积极处理后顺利完成手术;对照组无复发,1例术后出现硬膜外血肿,出现一侧肌力下降,急诊清除血肿后3个月下肢肌力逐渐恢复,1例感染,经I期清创置管冲洗后完全恢复。两组术中均无神经损伤、血管损伤、硬膜撕裂等严重并发症。结论经皮内镜下二次椎间孔成形技术为治疗腰椎管狭窄症安全有效的治疗方法,但对于中央管狭窄需慎用,同时,其在缩短手术时间、减少出血、降低住院费用及缩短住院时间上有一定的优势,有一定的推广价值。
Objective This research tried to investigate the clinical efficacy of endoscopic secondary foraminal shaping in the treatment of lumbar spinal stenosis.Methods A total of 68 cases of lumbar spinal stenosis patients were randomly divided into secondary intervertebral foramen forming percutaneous endoscopic group(observation group)and conventional surgery(control group).There were 34 cases in each group and the follow up lasted for 6~24 months.The surgical complications,operation time,intraoperative blood loss,hospital stay,hospitalization cost and the effect of surgery were all recorded.The clinical efficacy of the observation group was also documented.Results All68 patients were followed up for an average of 16 months.There was no statistical difference in gender,age or preoperative VAS score(P>0.05).Compared with the control group,the observation group had a shorter operation time,less intraoperative bleeding,shorter hospital stay,and less hospital cost,with statistically significant differences(P<0.05).After 1 week,1 month,6 months and the last follow⁃up,VAS and ODI scores of the patients in the two groups were all statistically different(P<0.05)within 1 month,but not statistically different(P>0.05)after 6 months.Moreover,the improved MacNab standard was used to evaluate the efficacy of the patients one year after the operation without statistically significant difference(P>0.05).During the observation period,2 patients in the observation group had repeated symptoms within 1 year,who were patients with central canal stenosis.After the second open operation,the symptoms disappeared;1 patient presented symptoms of intra⁃operative spinal cord hypertension,and successfully completed the operation after active treatment.In the control group,there was no recurrence.One patient developed epidural hematoma after surgery,and the muscle strength of one side decreased.After emergency hematoma removal,the muscle strength of the lower extremity gradually recovered 3 months later.There were no serious complications such as nerve injury,vascular injury and duraltear.Conclusion Percutaneous endoscopic secondary formingis a safe and effective methodfor the treatment of lumbar spinal stenosis.But it should be used with caution for the treatment of central stenosis.At the same time,it has certain advantages in shortening operation time,reducing bleeding,reducing hospitalization cost and shortening hospitalization time,and has certain promotion value.
作者
薛厚军
雷宇
黄杰彬
陈伟雄
王诗成
潘磊
XUE Houjun;LEI Yu;HUANG Jiebin;CHEN Weixiong;WANG Shicheng;PAN Lei(Department of Spine and Joint Surgery,Foshan Municipal Sixth People′s Hospital,Foshan 528100,China)
出处
《实用医学杂志》
CAS
北大核心
2021年第2期138-143,共6页
The Journal of Practical Medicine
基金
广东省医学科研基金项目(编号:B2018195)
佛山市科技局科研立项(编号:2018AB000675)。
关键词
经皮内窥镜
椎间孔成形
二次成形
腰椎管狭窄症
percutaneous endoscope
intervertebral foramen forming
secondary forming
lumbar spinal stenosis
