椎间孔镜下改良TESSYS技术联合270°神经根减压治疗腰椎管狭窄症疗效观察
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摘要
目的探讨椎间孔镜下改良TESSYS技术联合270°神经根减压治疗腰椎管狭窄症的临床疗效。方法回顾性分析三门峡市中心医院2012年1月至2015年1月收治的123例腰椎管狭窄症患者的临床资料,其中行经椎间孔腰椎椎体间融合术(TLIF)治疗61例(对照组),行椎间孔镜下改良TESSYS技术联合270°神经根减压治疗62例(观察组),比较2组患者手术创面面积、术中出血量、手术时间、卧床时间及住院费用;术前及术后7 d和3、6、12个月,使用视觉疼痛模拟评分(VAS)法评估患者术后腰腿疼痛情况,使用OSWESTRY功能障碍指数(ODI)评估患者腰椎功能改善情况。结果与对照组比较,观察组患者手术创面面积小(P<0.05),术中出血量少(P<0.05),手术时间、卧床时间短(P<0.05),住院费用低(P<0.05)。2组患者术前VAS评分和ODI比较差异无统计学意义(P>0.05);观察组患者术后7 d VAS评分和ODI显著低于对照组(P<0.05);而术后3、6、12个月2组患者VAS评分和ODI比较差异无统计学意义(P>0.05)。结论椎间孔镜下改良TESSYS技术联合270°神经根减压治疗腰椎管狭窄症具有手术创面面积小、术中出血量少、手术时间短、住院费用低等优点。
Objective The explore the clinical effect of improved TESSYS combined with 270° nerve root decompression on patients with lumbar spinal stenosis. Methods The clinical data of 123 patients with lumbar spinal stenosis disease who were treated in the Central Hospital of Sanmenxia City from January 2012 to January 2015 were analyzed retrospectively.There were 61 patients treated with transforaminal lumbar interbody fusion( control group),and 62 patients treated with improved TESSYS combined with 270° nerve root decompression( observation group). The area of surgical wound,peroperative bleeding,operation time,time in bed and hospitalization costs were compared between the two groups. The pain in waist and lower extremities after operation was evaluated by visual analogue scale( VAS),and the improvement of lumbar function was assessed by Oswestry disability index( ODI) before operation and at 7 days,3,6,12 months after operation. Results Compared with the control group,in the observation group the area of surgical wound was smaller( P < 0. 05),the peroperative bleeding was fewer( P < 0. 05),the operation time and time in bed were shorter( P < 0. 05),and hospitalization costs was lower( P < 0. 05). There was no significant difference in the VAS scores and ODI between the two groups before treatment( P >0. 05). The VAS scores and ODI in the observation group at 7 days after the operation were lower than that in the control group( P < 0. 05). There was no significant difference in the VAS scores and ODI between the two groups at 3,6,12 months after operation( P > 0. 05). Conclusion The clinical effect of improved TESSYS combined with 270° nerve root decompression on patients with lumbar spinal stenosis disease has the advantage of small surgical wound,few peroperative bleeding,short operation time and low hospitalization costs.
Objective The explore the clinical effect of improved TESSYS combined with 270° nerve root decompression on patients with lumbar spinal stenosis. Methods The clinical data of 123 patients with lumbar spinal stenosis disease who were treated in the Central Hospital of Sanmenxia City from January 2012 to January 2015 were analyzed retrospectively.There were 61 patients treated with transforaminal lumbar interbody fusion( control group),and 62 patients treated with improved TESSYS combined with 270° nerve root decompression( observation group). The area of surgical wound,peroperative bleeding,operation time,time in bed and hospitalization costs were compared between the two groups. The pain in waist and lower extremities after operation was evaluated by visual analogue scale( VAS),and the improvement of lumbar function was assessed by Oswestry disability index( ODI) before operation and at 7 days,3,6,12 months after operation. Results Compared with the control group,in the observation group the area of surgical wound was smaller( P < 0. 05),the peroperative bleeding was fewer( P < 0. 05),the operation time and time in bed were shorter( P < 0. 05),and hospitalization costs was lower( P < 0. 05). There was no significant difference in the VAS scores and ODI between the two groups before treatment( P >0. 05). The VAS scores and ODI in the observation group at 7 days after the operation were lower than that in the control group( P < 0. 05). There was no significant difference in the VAS scores and ODI between the two groups at 3,6,12 months after operation( P > 0. 05). Conclusion The clinical effect of improved TESSYS combined with 270° nerve root decompression on patients with lumbar spinal stenosis disease has the advantage of small surgical wound,few peroperative bleeding,short operation time and low hospitalization costs.
引文
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[2]盛晓文,陈兵乾,薛峰,等.后路椎间融合术和经椎间孔入路融合术治疗腰椎滑脱症的临床比较[J].颈腰痛杂志,2015,36(1):25-27.
[3]胥少汀,葛宝丰,徐印坎,等.实用骨科学[M].3版.北京:人民军医出版社,2006:1614-1618.
[4]刘海潮,李存孝,范德刚,等.椎弓根复合体钉钩系统治疗青年腰椎峡部裂[J].中华全科医学,2013,11(7):1007-1008.
[5]桂凯红,张海燕,黄林,等.微创单侧入路双侧减压固定与开放双侧减压固定治疗单间隙腰椎管狭窄症疗效比较[J].新乡医学院学报,2017,34(3):228-230,234.
[6]王英杰,陈雄生,贾连顺,等.腰椎椎管狭窄症融合方式的选择[J].脊柱外科杂志,2015,13(3):140-143.
[7]吴晓东,叶晓健,王新伟,等.腰椎椎间孔镜手术治疗伴神经根管狭窄的腰椎间盘突出症[J].脊柱外科杂志,2015,13(2):75-77.
[8]赵成毅,刘少喻,李青,等.神经根管减压术治疗腰椎神经根管狭窄症[J].临床骨科杂志,2012,15(1):1-3.
[9]贾连顺,杨立利.退变性腰椎管狭窄症的现代外科学概念[J].中华骨科杂志,2002,22(8):509-511.
[10]HSIEH P C,KOSKI T R O,SHAUGHNESSY B A,et al.Anterior lumbar interbody fusion in comparison with transforaminal lumbar interbody fusion:implications for the restoration of foraminal height,local disc angle,lumber lordosis,and sagittal balance[J].J Neurosurg Spine,2007,7(4):379-386.
[11]TOMLINSON T,CHEN J,UPASANI V,et al.Unilateral and bilateral sacropelvic fixation result in similar construct biomechanics[J].Spine,2008,33(20):2127-2133.
[12]李嵩鹏,周游,李定,等.椎间孔镜TESSYS入路相关的L5-S1节段椎间孔解剖学观测[J].中国临床解剖学杂志,2015,33(2):129-133.
[13]PARKER S L,ADOGWA O,BYDON A,et al.Cost-efectiveness of minimally invasive versus open transforaminal lumbar interbody fusion for degenerative spondylolisthesis associated low-back and leg pain over two years[J].World Neuro Surg,2012,78(1/2):178-184.