摘要
目的比较内镜下腰椎管成形术与减压植骨椎弓根钉内固定术治疗腰椎退行性变的疗效。方法选择2015年10月至2018年10月普宁市人民医院骨外科收治的80例腰椎退行性变患者为研究对象,根据随机数表法将患者分为观察组和对照组,每组40例。观察组采用内镜下腰椎管成形术,对照组采用开放减压植骨椎弓根钉内固定术。比较两组患者的手术时间、术中出血量、术后首次下床活动时间、住院时间、骨折愈合时间、疼痛视觉模拟评分(VAS)、日本骨科协会(JOA)评分、Oswestry功能障碍指数(ODI)、腰椎节段矢状曲度恢复率和并发症发生情况。结果观察组患者术中出血量为(175.36±25.59)mL,明显少于对照组的(232.51±46.25)mL,术后首次下床活动时间和住院时间分别为(2.65±0.52)d、(15.23±3.26)d,明显短于对照组的(7.58±2.16)d、(21.52±4.59)d,差异均有统计学意义(P<0.05);观察组患者术后VAS评分、ODI指数分别为(1.72±0.31)分、(20.54±8.07),明显低于对照组的(2.51±0.65)分、(26.52±9.08),JOA评分为(14.94±5.27)分,明显高于对照组的(12.27±4.93)分,差异均有统计学意义(P<0.05);观察组患者术后即刻、术后12个月固定腰椎节段矢状曲度恢复率分别为(92.87±6.73)%、(91.52±4.94)%,明显高于对照组的(84.26±7.01)%、(77.45±5.58)%,差异均有统计学意义(P<0.05);观察组患者要诟并发症率为5.0%,明显低于对照组的20.0%,差异有统计学意义(P<0.05)。结论与减压植骨椎弓根钉内固定术比较,内镜下腰椎管成形术可减少手术创伤、促使术后康复,更明显改善临床症状、恢复腰椎矢状曲度、恢复腰椎功能,降低并发症风险。
Objective To investigate the therapeutic effect of endoscopic lumbar angioplasty and decompression and pedicle screw fixation on lumbar degenerative change.Methods From October 2015 to October 2018,80 patients with lumbar degenerative change admitted to the People's Hospital of Puning were selected and divided into the control group and observation group according to random number table,with 40 patients in each group.The observation group was treated with endoscopic laminoplasty,while the control group was treated with open decompression and pedicle screw fixation.The operation time,intraoperative hemorrhage,the first time of getting out of bed after operation,the time of hospitalization after operation,time of fracture healing,pain visual analogue score(VAS),Japanese Orthopaedic Association(JOA)score,Oswestry dysfunction index(ODI),lumbar sagittal curvature recovery rate and complications were compared between the two groups.Results The amount of bleeding in the observation group was(175.36±25.59)mL,which was significantly less than(232.51±46.25)mL in the control group(P<0.05).The first time of getting out of bed and the first time of hospitalization in the observation group were(2.65±0.52)d and(15.23±3.26)d,respectively,which were significantly shorter than corresponding(7.58±2.16)d and(21.52±4.59)d in the control group(P<0.05).The VAS score and ODI index of the observation group were 1.72±0.31 and 20.54±8.07,respectively,which were significantly lower than corresponding 2.51±0.65 and 26.52±9.08 of the control group(P<0.05).JOA score of the observation group was(14.94±5.27),which was significantly higher than(12.27±4.93)of the control group(P<0.05).In the observation group,the recovery rates of sagittal curvature immediately and 12 months after operation were(92.87±6.73)%and(91.52±4.94)%,which were significantly higher than corresponding(84.26±7.01)%and(77.45±5.58)%of the control group(P<0.05).The complication rate of the observation group was 5.0%versus 20.0%of the control group(P<0.05).Conclusion Compared with decompression and pedicle screw fixation,endoscopic lumbar angioplasty can reduce surgical trauma and promote postoperative rehabilitation with more obvious improvement of clinical symptoms,recovery of lumbar sagittal curvature,recovery of lumbar function,which reduce the risk of complications.
作者
江钦文
赖沛群
黄国鹏
JIANG Qin-wen;LAI Pei-qun;HUANG Guo-peng(Department of Orthopedics,the People's Hospital of Puning,Puning 515300,Guangdong,CHINA)
出处
《海南医学》
CAS
2020年第16期2063-2066,共4页
Hainan Medical Journal
关键词
内镜下腰椎管成形术
减压植骨椎弓根钉内固定术
腰椎退行性变
内镜
腰椎病
疗效
Endoscopic laminoplasty
Decompression and pedicle screw fixation
Lumbar degenerative change
Endoscopy
Lumbar diseases
Curative effect
