椎间孔镜BEIS技术与TLIF手术治疗老年腰椎管狭窄症的疗效比较
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摘要
目的比较经皮椎间孔镜下BEIS技术与经椎间孔入路腰椎椎体间融合术(TLIF)治疗老年腰椎管狭窄症的临床疗效。方法纳入自2012-01—2014-01诊治的60例老年腰椎管狭窄症,31例采用BEIS技术行经皮椎间孔镜下髓核摘除射频消融术治疗(BEIS组),29例采用TLIF术治疗(TLIF组)。比较2组手术时间、术中出血量、术后卧床时间、住院时间,术后1个月、1年、3年下肢疼痛VAS评分、JOA评分,以及末次随访时改良MacNab评分。结果 60例均获得3年完整随访,所有患者均未出现硬膜囊、神经、血管损伤,术后未出现感染。TLIF组植骨均融合,未出现内固定松动断裂。与TLIF组比较,BEIS组手术时间更短、术中出血量更少,术后卧床时间及住院时间也更短,差异有统计学意义(P <0.05)。BEIS组术后1个月、1年、3年下肢疼痛VAS评分、JOA评分优于TLIF组,末次随访时改良MacNab评分优于TLIF组,差异有统计学意义(P <0.05)。结论与TLIF手术比较,经皮椎间孔镜下BEIS技术治疗老年腰椎管狭窄症符合微创理念,可以加快患者术后康复,疗效良好且保持稳定。
Objective To compare the clinical efficacy of percutaneous transforaminal BEIS and transforaminal lumbar interbody fusion(TLIF) in the treatment of senile lumbar spinal stenosis. Methods Sixty elderly patients with lumbar spinal stenosis were included from January 2012 to January 2014. Thirty-one patients underwent percutaneous transforaminal endoscopic nucleus pulposus ablation(BEIS group) and 29 patients underwent TLIF(TLIF group). The operation time,intraoperative bleeding volume, bedridden time, hospital stay, VAS score, JOA score of lower limb pain at 1 month, 1 year and3 years after operation, and modified MacNab score at the last follow-up were compared between the two groups. Results Sixty patients were followed up for 3 years. No dural sac, nerve or blood vessel injury occurred in all patients, and no infection occurred after operation. In TLIF group, all bone grafts were fused without loosening or fracture of internal fixation. Compared with TLIF group, BEIS group had shorter operation time, less intraoperative bleeding, shorter bed-rest time and hospitalization time after operation(P <0.05). The VAS and JOA scores of lower limb pain in BEIS group were better than those in TLIF group at 1 month, 1 year and 3 years after operation, and the modified MacNab score was better than that in TLIF group at the last follow-up(P <0.05). Conclusion Compared with TLIF, percutaneous transforaminal BEIS is a minimally invasive technique for the treatment of senile lumbar spinal stenosis. It can accelerate the recovery of patients after operation, and has a good effect and stability.
Objective To compare the clinical efficacy of percutaneous transforaminal BEIS and transforaminal lumbar interbody fusion(TLIF) in the treatment of senile lumbar spinal stenosis. Methods Sixty elderly patients with lumbar spinal stenosis were included from January 2012 to January 2014. Thirty-one patients underwent percutaneous transforaminal endoscopic nucleus pulposus ablation(BEIS group) and 29 patients underwent TLIF(TLIF group). The operation time,intraoperative bleeding volume, bedridden time, hospital stay, VAS score, JOA score of lower limb pain at 1 month, 1 year and3 years after operation, and modified MacNab score at the last follow-up were compared between the two groups. Results Sixty patients were followed up for 3 years. No dural sac, nerve or blood vessel injury occurred in all patients, and no infection occurred after operation. In TLIF group, all bone grafts were fused without loosening or fracture of internal fixation. Compared with TLIF group, BEIS group had shorter operation time, less intraoperative bleeding, shorter bed-rest time and hospitalization time after operation(P <0.05). The VAS and JOA scores of lower limb pain in BEIS group were better than those in TLIF group at 1 month, 1 year and 3 years after operation, and the modified MacNab score was better than that in TLIF group at the last follow-up(P <0.05). Conclusion Compared with TLIF, percutaneous transforaminal BEIS is a minimally invasive technique for the treatment of senile lumbar spinal stenosis. It can accelerate the recovery of patients after operation, and has a good effect and stability.
引文
[1]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,2006:1678-1708.
[2]Nellensteijn J,Ostelo R,Bartels R,et al.Transforaminal endoscopic surgery for symptomatic lumbar disc herniations:a systematic review of the literature[J].Eur Spine J,2010,19(2):181-204.
[3]Wang M,Zhou Y,Wang J,et al.A 10-year follow-up study on long-term clinical outcomes of lumbar microendoscopic discectomy[J].J Neurol Surg A Cent Eur Neurosurg,2012,73(4):195-198.
[4]Ahn Y,Kim CH,Lee JH,et al.Radiation exposure to the surgeon during percutaneous endoscopic lumbar discectomy:a prospective study[J].Spine(Phila Pa 1976),2013,38(7):617-625.
[5]Choi I,Ahn JO,So WS,et al.Exiting root injury in transforaminal endoscopic discectomy:preoperative image considerations for safety[J].Eur Spine J,2013,22(11):2481-2487.
[6]白一冰.椎间孔镜BEIS技术操作规范[M].北京:人民卫生出版社,2015:27.
[7]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.
[8]Aizawa T,Kokubun S,Ozawa H,et al.Increasing incidence of degenerative spinal diseases in Japan during 25 years:the registration system of spinal surgery in Tohoku university spine society[J].Tohoku J Exp Med,2016,238(2):153-163.
[9]Ghogawala Z,Dziura J,Butler WE,et al.Laminectomy plus fusion versus laminectomy alone for lumbar spondylolisthesis[J].N Engl JMed,2016,374(15):1424-1434.
[10]Fujimoto T,Taniwaki T,Tahata S,et al.Patient outcomes for a minimally invasive approach to treat lumbar spinal canal stenosis:is microendoscopic or microscopic decompressive laminotomy the less invasive surgery[J].Clin Neurol Neurosurg,2015,131:21-25.
[11]保国锋,李卫东,徐冠华.经皮椎板间隙入路270°椎管减压治疗腰椎管狭窄症[J].中国矫形外科杂志,2017,25(3):264-269.
[12]Thome C,Zevgaridis D,Leheta O,et al.Outcome after less-invasive decompression of lumbar spinal stenosis:randomized comparison of unilateral laminotomy,bilateral laminotomy,and laminectomy[J].J Neurosurg Spine,2005,3(2):129-141.
[13]Ren L,Han Z,Zhang J,et al.Efficacy of percutaneous laser disc decompression on lumbar spinal stenosis[J].Lasers Med Sci,2014,29(3):921-923.
[14]Lee JC,Kim Y,Soh JW,et al.Risk factors of adjacent segment disease requiring surgery after lumbar spinal fusion:comparison of posterior lumbar interbody fusion and posterolateral fusion[J].Spine(Phila Pa 1976),2014,39(5):E339-345.
[15]陈佳佳,崔志明.微创内镜下手术治疗退变性腰椎管狭窄症的研究进展[J/CD].中华临床医师杂志:电子版,2017,11(3):458-461.
[16]陈志文,马岩,李同涛,等.经皮椎间孔镜技术与MIS-TLIF手术治疗腰椎管狭窄症的疗效比较[J].中国骨与关节损伤杂志,2018,33(9):969-971.
[17]银和平,吴一民,李树文,等.显微内窥镜下椎间融合治疗退变性腰椎失稳症[J].中国骨与关节损伤杂志,2010,25(3):242-243.
[18]刘宝平,孙义忠,王峰宝,等.椎间孔镜与开窗治疗椎间盘突出症术后影像学分析[J].中国骨与关节损伤杂志,2012,27(9):826-827.
[19]李振宙,吴闻文,侯树勋,等.经皮侧后路腰椎间孔成形手术器械的设计及临床应用[J].中华骨科杂志,2011,31(10):1026-1032.
[20]Kim CH,Chung CK,Sohn S,et al.The surgical outcome and the surgical strategy of percutaneous endoscopic discectomy for recurrent disk herniation[J].J Spinal Disord Tech,2014,27(8):415-422.
[2]Nellensteijn J,Ostelo R,Bartels R,et al.Transforaminal endoscopic surgery for symptomatic lumbar disc herniations:a systematic review of the literature[J].Eur Spine J,2010,19(2):181-204.
[3]Wang M,Zhou Y,Wang J,et al.A 10-year follow-up study on long-term clinical outcomes of lumbar microendoscopic discectomy[J].J Neurol Surg A Cent Eur Neurosurg,2012,73(4):195-198.
[4]Ahn Y,Kim CH,Lee JH,et al.Radiation exposure to the surgeon during percutaneous endoscopic lumbar discectomy:a prospective study[J].Spine(Phila Pa 1976),2013,38(7):617-625.
[5]Choi I,Ahn JO,So WS,et al.Exiting root injury in transforaminal endoscopic discectomy:preoperative image considerations for safety[J].Eur Spine J,2013,22(11):2481-2487.
[6]白一冰.椎间孔镜BEIS技术操作规范[M].北京:人民卫生出版社,2015:27.
[7]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.
[8]Aizawa T,Kokubun S,Ozawa H,et al.Increasing incidence of degenerative spinal diseases in Japan during 25 years:the registration system of spinal surgery in Tohoku university spine society[J].Tohoku J Exp Med,2016,238(2):153-163.
[9]Ghogawala Z,Dziura J,Butler WE,et al.Laminectomy plus fusion versus laminectomy alone for lumbar spondylolisthesis[J].N Engl JMed,2016,374(15):1424-1434.
[10]Fujimoto T,Taniwaki T,Tahata S,et al.Patient outcomes for a minimally invasive approach to treat lumbar spinal canal stenosis:is microendoscopic or microscopic decompressive laminotomy the less invasive surgery[J].Clin Neurol Neurosurg,2015,131:21-25.
[11]保国锋,李卫东,徐冠华.经皮椎板间隙入路270°椎管减压治疗腰椎管狭窄症[J].中国矫形外科杂志,2017,25(3):264-269.
[12]Thome C,Zevgaridis D,Leheta O,et al.Outcome after less-invasive decompression of lumbar spinal stenosis:randomized comparison of unilateral laminotomy,bilateral laminotomy,and laminectomy[J].J Neurosurg Spine,2005,3(2):129-141.
[13]Ren L,Han Z,Zhang J,et al.Efficacy of percutaneous laser disc decompression on lumbar spinal stenosis[J].Lasers Med Sci,2014,29(3):921-923.
[14]Lee JC,Kim Y,Soh JW,et al.Risk factors of adjacent segment disease requiring surgery after lumbar spinal fusion:comparison of posterior lumbar interbody fusion and posterolateral fusion[J].Spine(Phila Pa 1976),2014,39(5):E339-345.
[15]陈佳佳,崔志明.微创内镜下手术治疗退变性腰椎管狭窄症的研究进展[J/CD].中华临床医师杂志:电子版,2017,11(3):458-461.
[16]陈志文,马岩,李同涛,等.经皮椎间孔镜技术与MIS-TLIF手术治疗腰椎管狭窄症的疗效比较[J].中国骨与关节损伤杂志,2018,33(9):969-971.
[17]银和平,吴一民,李树文,等.显微内窥镜下椎间融合治疗退变性腰椎失稳症[J].中国骨与关节损伤杂志,2010,25(3):242-243.
[18]刘宝平,孙义忠,王峰宝,等.椎间孔镜与开窗治疗椎间盘突出症术后影像学分析[J].中国骨与关节损伤杂志,2012,27(9):826-827.
[19]李振宙,吴闻文,侯树勋,等.经皮侧后路腰椎间孔成形手术器械的设计及临床应用[J].中华骨科杂志,2011,31(10):1026-1032.
[20]Kim CH,Chung CK,Sohn S,et al.The surgical outcome and the surgical strategy of percutaneous endoscopic discectomy for recurrent disk herniation[J].J Spinal Disord Tech,2014,27(8):415-422.