经皮椎板间入路内镜下椎管减压术在老年腰椎侧隐窝狭窄症治疗中的应用
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摘要
目的探讨经皮椎板间入路内镜下椎管减压术治疗老年腰椎侧隐窝狭窄症的临床效果。方法老年腰椎侧隐窝狭窄症患者196例,根据手术方法不同分为观察组和对照组各98例,观察组行经皮椎板间入路内镜下椎管减压术,对照组行经皮椎间孔入路内镜下椎管减压术。2组分别于术前,术后7d以及术后1、3个月,采用视觉模拟评分(visual analogue scale,VAS)评估患者下肢疼痛程度,采用Oswestry功能障碍指数(Oswestry disability index,ODI)评定患者腰椎功能,采用侧隐窝角评估侧隐窝狭窄程度,依据MacNab标准评定2组手术治疗效果,并记录手术并发症。结果 2组术前下肢疼痛VAS评分、腰椎功能ODI评分、软性侧隐窝角及骨性侧隐窝角比较差异均无统计学意义(P>0.05),术后7d,1、3个月时观察组VAS评分[(3.51±1.32)、(2.42±0.66)、(1.48±0.56)分]、ODI评分[(31.37±9.38)、(12.53±6.83)、(12.78±7.73)分]低于对照组[(5.25±2.61)、(3.38±1.37)、(2.99±1.52)分,(38.52±12.65)、(19.02±9.85)、(18.93±8.56)分],且2组均低于术前(P<0.05),术后7d时观察组骨性侧隐窝角、软性侧隐窝角[(34.18±10.36)°、(30.53±9.76)°]大于对照组[(30.52±9.85)°、(27.27±8.39)°](P<0.05),且2组均大于术前(P<0.05);术后3个月,观察组治疗优良率(93.88%)与对照组(88.78%)比较差异无统计学意义(P>0.05);2组术后均未出现严重并发症,观察组术后并发症发生率(2.04%)与对照组(5.10%)比较差异无统计学意义(P>0.05)。结论与经皮椎间孔入路比较,行经皮椎板间入路内镜下椎管减压术对减轻老年腰椎侧隐窝狭窄症患者下肢疼痛、改善侧隐窝狭窄及腰椎功能效果更明显。
Objective To investigate the clinical effect of percutaneus endoscopic interlaminar decompression on lumbar lateral recess stenosis in the elderly.Methods Totally 196 elderly patients with lumbar lateral recess stenosis were divided into observation group receiving percutaneus endoscopic interlaminar decompression and control group receiving percutaneous endoscopic transforaminal discectomy,with 98 patients in each group.The pain degree of lower extremity was assessed by visual analogue scale(VAS)before surgery,and in 7 days,1 month and 3 months after surgery.Oswestry disability index(ODI)was used to assess lumbar function.The degree of lateral recess stenosis was assessed by lateral recess angle.The surgical outcomes were evaluated in two groups according to MacNab criteria,and surgical complications were recorded.Results There were no significant differences in VAS score of the lower extremity,lumbar ODI score,soft lateral recess angle and osteal recess angle between two groups before operation(P>0.05).The VAS scores of the lower extremity(3.51±1.32,2.42±0.66,1.48±0.56)and lumbar ODI scores(31.37±9.38,12.53±6.83,12.78±7.73)in observation group were significantly lower than those in control group(5.25±2.61,3.38±1.37,2.99±1.52;38.52±12.65,19.02±9.85,18.93±8.56)in 7 days,1 month and 3 months after operation(P<0.05),and all above indexes were significantly lower than those before operation(P<0.05).The osteal recess angle and soft lateral recess angle were significantly larger in observation group((34.18±10.36)°,(30.53±9.76)°)than those in control group((30.52±9.85)°,(27.27±8.39)°)in 7 days after operation(P<0.05),which were significantly larger than those before operation(P<0.05).There were no significant differences in the excellent rate between observation group(93.88%)and control group(88.78%)in 3 months after operation(P>0.05),and in the postoperative complications incidences between observation group(2.04%)and control group(5.10%)(P>0.05).No severe complications occurred in both groups after operation.Conclusion Percutaneus endoscopic interlaminar decompression is superior to percutaneous endoscopic transforaminal decompression in reducing lower extremity pain,relieving lateral recess stenosis and improving lumbar function in elderly patients with lumbar stenosis.
Objective To investigate the clinical effect of percutaneus endoscopic interlaminar decompression on lumbar lateral recess stenosis in the elderly.Methods Totally 196 elderly patients with lumbar lateral recess stenosis were divided into observation group receiving percutaneus endoscopic interlaminar decompression and control group receiving percutaneous endoscopic transforaminal discectomy,with 98 patients in each group.The pain degree of lower extremity was assessed by visual analogue scale(VAS)before surgery,and in 7 days,1 month and 3 months after surgery.Oswestry disability index(ODI)was used to assess lumbar function.The degree of lateral recess stenosis was assessed by lateral recess angle.The surgical outcomes were evaluated in two groups according to MacNab criteria,and surgical complications were recorded.Results There were no significant differences in VAS score of the lower extremity,lumbar ODI score,soft lateral recess angle and osteal recess angle between two groups before operation(P>0.05).The VAS scores of the lower extremity(3.51±1.32,2.42±0.66,1.48±0.56)and lumbar ODI scores(31.37±9.38,12.53±6.83,12.78±7.73)in observation group were significantly lower than those in control group(5.25±2.61,3.38±1.37,2.99±1.52;38.52±12.65,19.02±9.85,18.93±8.56)in 7 days,1 month and 3 months after operation(P<0.05),and all above indexes were significantly lower than those before operation(P<0.05).The osteal recess angle and soft lateral recess angle were significantly larger in observation group((34.18±10.36)°,(30.53±9.76)°)than those in control group((30.52±9.85)°,(27.27±8.39)°)in 7 days after operation(P<0.05),which were significantly larger than those before operation(P<0.05).There were no significant differences in the excellent rate between observation group(93.88%)and control group(88.78%)in 3 months after operation(P>0.05),and in the postoperative complications incidences between observation group(2.04%)and control group(5.10%)(P>0.05).No severe complications occurred in both groups after operation.Conclusion Percutaneus endoscopic interlaminar decompression is superior to percutaneous endoscopic transforaminal decompression in reducing lower extremity pain,relieving lateral recess stenosis and improving lumbar function in elderly patients with lumbar stenosis.
引文
[1]刘道德,付志彬,周凌,等.退变性腰椎管狭窄症椎管减压后融合固定手术疗效分析[J].中华实用诊断与治疗杂志,2013,27(9):923-925.
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[6]李振宙,侯树勋,商卫林,等.经皮内镜下经椎间孔入路腰椎侧隐窝减压术:技术要点及2a随访结果[J].中国骨与关节杂志,2016,5(5):333-338.
[7]闫继强,贾慧雯,高明林.经皮椎间孔入路内镜下减压治疗单节段老年腰椎侧隐窝狭窄症36例[J].颈腰痛杂志,2018,39(1):31-34.
[8]郭建斌,闻振坤,李坤,等.全膝关节置换术治疗骨关节炎及类风湿性关节炎效果比较[J].中华实用诊断与治疗杂志,2018,32(3):258-261.
[9]王祥强,苗峰,卜志勇.植骨固定术与选择性减压术治疗腰椎退行性滑脱症效果比较[J].中华实用诊断与治疗杂志,2018,32(1):64-66.
[10]MACNAB I.Negative disc exploration:an analysis of the causes of nerve-root involvement in sixty-eight patients[J].J Bone Joint Surg Am,1971,53(5):891-903.
[11] REN C, SONG Y, LIU L, et al. Adjacent segment degeneration and disease after lumbar fusion compared with motion-preserving procedures:a meta-analysis[J].Eur J Orthop Surg Traumatol,2014,24(1):245-253.
[12]徐宝山.经皮椎间孔镜和椎间盘镜治疗腰椎间盘突出症和椎管狭窄症的选择与应用[J].天津医药,2015,43(11):1239-1243.
[13]李振宙,侯树勋,宋科冉,等.经皮经椎板间隙入路完全内镜下腰椎侧隐窝减压术的近期随访报告[J].中国骨与关节杂志,2014,3(8):585-589.
[14] RUETTEN S,KOMP M,HAHN P,et al.Decompression of lumbar lateral spinal stenosis:full-endoscopic,interlaminar technique[J].Oper Orthop Traumatol,2013,25(1):31-46.
[2]燕好军,黄林海,张大威,等.椎板间撑开椎管潜行扩大减压术治疗老年退行性腰椎管狭窄症[J].中国实用医药,2015,10(21):74-75.
[3] DEZAWA A, MIKAMI H, SAIRYO K. Percutaneous endoscopic translaminar approach for herniated nucleus pulposus in the hidden zone of the lumbar spine[J].Asian J Endosc Surg,2012,5(4):200-203.
[4]陈康,曾建成,修鹏,等.经皮椎板间入路内镜下椎管减压治疗老年腰椎侧隐窝狭窄症[J].中华骨科杂志,2018,38(8):458-467.
[5]于江涛,范少勇,陶志强,等.全麻下经椎板间隙入路经皮内镜下治疗老年性腰椎管狭窄症50例[J].江西中医药,2018,49(6):47-49.
[6]李振宙,侯树勋,商卫林,等.经皮内镜下经椎间孔入路腰椎侧隐窝减压术:技术要点及2a随访结果[J].中国骨与关节杂志,2016,5(5):333-338.
[7]闫继强,贾慧雯,高明林.经皮椎间孔入路内镜下减压治疗单节段老年腰椎侧隐窝狭窄症36例[J].颈腰痛杂志,2018,39(1):31-34.
[8]郭建斌,闻振坤,李坤,等.全膝关节置换术治疗骨关节炎及类风湿性关节炎效果比较[J].中华实用诊断与治疗杂志,2018,32(3):258-261.
[9]王祥强,苗峰,卜志勇.植骨固定术与选择性减压术治疗腰椎退行性滑脱症效果比较[J].中华实用诊断与治疗杂志,2018,32(1):64-66.
[10]MACNAB I.Negative disc exploration:an analysis of the causes of nerve-root involvement in sixty-eight patients[J].J Bone Joint Surg Am,1971,53(5):891-903.
[11] REN C, SONG Y, LIU L, et al. Adjacent segment degeneration and disease after lumbar fusion compared with motion-preserving procedures:a meta-analysis[J].Eur J Orthop Surg Traumatol,2014,24(1):245-253.
[12]徐宝山.经皮椎间孔镜和椎间盘镜治疗腰椎间盘突出症和椎管狭窄症的选择与应用[J].天津医药,2015,43(11):1239-1243.
[13]李振宙,侯树勋,宋科冉,等.经皮经椎板间隙入路完全内镜下腰椎侧隐窝减压术的近期随访报告[J].中国骨与关节杂志,2014,3(8):585-589.
[14] RUETTEN S,KOMP M,HAHN P,et al.Decompression of lumbar lateral spinal stenosis:full-endoscopic,interlaminar technique[J].Oper Orthop Traumatol,2013,25(1):31-46.