内镜下椎间孔成形术治疗老年腰椎侧隐窝狭窄症的疗效分析

Clinical outcomes of foraminoplasty under endoscopy in the treatment of elderly lumbar lateral recess stenosis

中文关键词:  椎间孔成形  侧隐窝狭窄症  经皮内镜  老年

英文关键词:Foraminoplasty  Lateral recess stenosis  Percutaneous endoscopy  Elderly

中文摘要:

  【摘要】 目的：分析内镜下椎间孔成形术治疗老年腰椎侧隐窝狭窄症的临床效果。方法：回顾性分析2018年1月~2019年1月在我院接受手术治疗的150例腰椎侧隐窝狭窄症患者病历资料，其中男87例，女63例，年龄68.6±10.7岁（63~79岁）。随访时间为33.7±9.3（29~41）个月。92例患者采用内镜下椎间孔成形术治疗（内镜组），58例患者采用传统椎板开窗椎管减压手术治疗（开窗组）。比较两组患者切口长度、手术时间、术中出血量、术后住院时间及并发症情况，测量术前及术后1个月骨性侧隐窝角、软性侧隐窝角评估减压程度。收集术前、术后1、3、6、12个月及末次随访时两组患者疼痛视觉模拟评分（visual analogue scale，VAS）、Oswestry功能障碍指数（Oswestry disability index，ODI）及健康调查简表（MOS 36-item short-form health survey，SF-36）评分评估手术效果，末次随访时采用MacNab标准评估临床疗效。根据不同手术节段进行亚组分析，比较不同手术节段间的疗效差异。结果：切口长度内镜组（9.36±1.40mm）少于开窗组（30.90±7.95mm），差异有统计学意义（t=32.632，P=0.000）；术中出血量内镜组（27.17±5.12ml）少于开窗组（77.03±12.37ml），差异有统计学意义（t=27.825，P=0.000）；术后住院时间内镜组（3.34±0.91d）少于开窗组（5.00±1.16d），差异有统计学意义（t=8.344，P=0.000）；而两组手术时间的差异无统计学意义（P＞0.05）。术后1个月CT、MRI影像显示两组骨性侧隐窝角及软性侧隐窝角差异无统计学意义（P＞0.05）。术后1、3个月内镜组ODI均低于开窗组，差异具有统计学意义（P＜0.001）；末次随访时内镜组SF-36评分（69.47±10.58）高于开窗组（61.36±10.26），差异有统计学意义（t=2.694，P=0.009）。两组患者术后各随访时间点的VAS评分、ODI、SF-36评分较术前均有显著改善（P＜0.05）。内镜组2例发生神经根外膜损伤，内镜组2例、开窗组4例发生硬膜损伤，术后密切观察病情变化。开窗组患者均顺利拔管，1例发生切口脂肪液化，术后切口延期愈合。亚组分析结果与整体结果大致相同，不同节段间的疗效无显著差异。结论：相较于传统椎板开窗减压术式，内镜下椎间孔成形术治疗老年腰椎侧隐窝狭窄症具有术后早期腰椎功能恢复快、改善生活质量等优势。

英文摘要:

  【Abstract】 Objectives: To analyze the clinical effect of endoscopic foraminoplasty in the treatment of lumbar lateral recess stenosis in elderly patients. Methods: The medical records of 150 patients who underwent surgery for lumbar lateral recess stenosis in our hospital from January 2018 to January 2019 were retrospectively analyzed, including 87 males and 63 females, aged 68.6±10.7 years(63-79 years) and were follwed up for 33.7±9.3(29-41) months. The patients were were divided into endoscopy group(n=92) treated with foraminoplasty under endoscopy and open group(n=58) treated with traditional lamine-fenestration spinal decompression surgery. The incision length, operation time, intraoperative blood loss, postoperative hospital stay, and complications between the two groups were compared, and the degree of decompression was evaluated by comparing the preoperative and postoperative 1 month bone lateral recess angle and soft lateral recess angle. The surgical effect was evaluated by visual anlog scale(VAS), Oswestry disability index(ODI) and MOS 36-item short-form health survey(SF-36) at preoperation and postoperative 1, 3, 6, and 12 months, and final follow-up, and the MacNab criteria were used to evaluate the clinical effect at the last follow-up. Subgroup analyses were performed according to different surgical segments to compare differences in efficacy. Results: The incision length of endoscopy group(9.36±1.40mm) was shorter than that of open group(30.90±7.95mm), and the difference was statistically significant(t=32.632, P=0.000). The intraoperative blood loss of the endoscopy group(27.17±5.12ml) was less than that of the open group(77.03±12.37ml) with significant difference(t=27.825, P=0.000). The postoperative hospital stay of the endoscopy group(3.34±0.91d) was shorter than that of the open group(5.00±1.16d) with significant difference(t=8.344, P=0.000). There was no significant difference in operation time between the two groups(P>0.05). CT and MRI at 1 month after surgery showed that there was no significant difference in bone and soft recess angles between the two groups(P>0.05). ODI of endoscopy group was lower than that of open group at 1 and 3 months after operation, and the differences were statistically significant(P<0.001). At final follow-up, the SF-36 score of endoscopy group(69.47±10.58) was higher than that of open group(61.36±10.26), and the difference was statistically significant(t=2.694, P=0.009). The VAS score, ODI and SF-36 score of the same group at each follow-up time after operation were significantly different from those before operation(P<0.05). 2 cases in the endoscopy group suffered nerve root injury, 2 cases in the endoscopy group and 4 cases in the open group suffered dural injury, and the condition changes of the patients were closely observed after surgery. The patients in the open group were successfully extubated, and 1 patient occurred fat liquefaction of the incision, and the healing of the incision was delayed after operation. The results of subgroup analyses were approximately the same as the overall results. Conclusions: Endoscopic foraminoplasty is superior in early postoperative recovery of lumbar function and improvement of quality of life in the long-term than traditional laminae-fenestration spinal decompression surgery in the treatment of elderly lumbar lateral recess stenosis.