摘要
目的 比较经皮椎间孔镜下减压术与改良后路减压融合内固定术在治疗老年性腰椎管狭窄症的临床疗效.方法 回顾分析78例获得完整随访的老年性腰椎管狭窄症患者的治疗情况.根据手术方法 患者分为2组,开放手术组:40例行改良后路减压融合内固定术(改良PLIF),微创手术组:38例行经皮椎间孔镜下减压术.记录两组患者围手术期观察指标、视觉疼痛模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)和改良Macnab疗效评定标准对手术疗效进行评估.结果 微创手术组患者手术时间、切口长度、术中出血量、住院时间及术后并发症发生率明显优于开放手术组,差异具有统计学意义(P<0.05).微创手术组手术优良率(89.47%)明显优于开放手术组(80.00%),差异具有统计学意义(P<0.05).随访结果 显示微创手术组术后各时间段VAS评分、ODI评分均优于开放手术组,差异具有统计学意义(P<0.05).术后1年两组患者VAS评分、ODI评分差异无统计学意义(P>0.05).结论 对于老年性腰椎管狭窄症患者,经皮椎间孔镜技术能够取得与改良PLIF手术相似的临床效果,但经皮椎间孔镜技术在手术时间、切口长度、术中出血量、住院时间、术后并发症等方面具有明显优势,并且对脊柱稳定性影响较小,症状改善明显,术后恢复较快,疗效确切.但在临床应用上,需要严格把握手术适应证.
Objective To compare the clinical efficacy of percutaneous endoscopic discectomy and posterior decompression fusion internal fixation in the treatment of senile lumbar spinal stenosis.Methods A retrospective analysis was made on the treatment of 78 cases of senile lumbar spinal stenosis with complete follow-up.The patients were divided into 2 groups according to the surgical method.In open surgery group,40 patients underwent the posterior decompression fusion internal fixation(improved PLIF);in minimally invasive surgery group,38 patients underwent percutaneous endoscopic discectomy.Perioperative observation indicators,visual analogue scale(VAS),Oswestry disability index(ODI)and modified Macnab efficacy evaluation criteria were recorded to evaluate the surgical efficacy of the two groups.Results The operative time,incision length,intraoperative blood loss,length of stay and incidence of postoperative complications in the minimally invasive surgery group were significantly better than those in the open surgery group,with statistically significant differences(P<0.05).The excellent and good rate(89.47%)of the minimally invasive surgery group was significantly better than that of the open surgery group(80.00%),and the difference was statistically significant(P<0.05).The follow-up results showed that VAS score and ODI score of minimally invasive surgery group were better than those of the open surgery group in each postoperative period,and the differences were statistically significant(P<0.05).There was no significant difference in VAS score and ODI score between the two groups one year after surgery.Conclusion For patients with senile lumbar spinal stenosis disease,percutaneous intervertebral foramen mirror technology can obtain similar to improved PLIF surgical clinical effect,but percutaneous intervertebral foramen mirror technology in operation time,incision length,intraoperative blood loss,hospital stay,postoperative complications,etc,has obvious advantages,and has little effect on the stability of the spine,symptoms improved significantly,postoperative recovery faster,curative effect.But in the clinical application,the operative indications should be strictly controlled.
作者
黄群
朱现玮
严飞
徐炜
徐沁
周志平
HUANG Qun;ZHU Xian-wei;YAN Fei;XU Wei;XU Qin;ZHOU Zhi-ping(Zhangjiagang Hospital Affiliated to Soochow University,Zhangjiagang,Jiangsu,215600,China)
出处
《中国血液流变学杂志》
CAS
2020年第3期287-292,共6页
Chinese Journal of Hemorheology
基金
国家自然科学基金资助项目(81874008)
关键词
腰椎管狭窄症
经皮椎间孔镜
后路减压融合内固定
老年
lumbar spinal stenosis
percutaneous interforaminal mirror
posterior decompression fusion internal fixation
elderly patients
