可视化椎间孔镜技术与纤维内窥镜下椎间盘切除术治疗腰椎侧隐窝狭窄症的近期疗效比较

Comparison of the short-term curative effect of visualization of percutaneous transforaminal endoscopic discectomy and microendoscopic discectomy in the treatment of lumbar spinal stenosis

中文关键词:  腰椎管狭窄症  腰椎间盘突出症  椎间孔镜  椎间盘镜  微创技术

英文关键词:Lumbar spinal stenosis  Lumbar disc herniation  Percutaneous endoscopic lumbar discectomy(PELD)  Microendoscopic discectomy(MED)  Minimally invasive technique

中文摘要:

  【摘要】 目的：比较可视化椎间孔镜技术（可视化经皮经椎间孔内窥镜下椎间盘切除术，visualization of percutaneous transforaminal endoscopic discectomy，VPTED）与显微内窥镜下椎间盘切除术（microendoscopic discectomy，MED）治疗腰椎侧隐窝狭窄症的近期临床疗效。方法：选取我院2016年3月~2017年3月收治的49例单节段腰椎侧隐窝狭窄合并腰椎间盘突出症患者，其中21例接受VPTED治疗，28例接受MED治疗，记录两组患者的手术切口长度、术中透视次数、手术时间、住院天数、住院费用；采用视觉模拟评分法（visual analogue scale/score，VAS）评估手术疗效，应用Oswestry功能指数（Oswestry disability index，ODI）评价临床疗效，末次随访行改良MacNab标准评估患者的疗效。结果：两组患者年龄、男女比例、随访时间、腰痛症状、肌力减退、感觉障碍及腱反射、突出节段（L3/4、L4/5、L5/S1）等一般情况无统计学差异（P＞0.05）。两组组内术后与术前VAS、ODI评分相比有统计学差异（P＜0.05），同时间点组间比较VAS、ODI评分无统计学差异（P＞0.05）。VPTED组手术切口长度（0.78±0.06cm）较MED组（1.95±0.12cm）小，手术时间（87.51±30.46min）较MED组（47.53±13.61min）长，透视次数（15.86±2.66）较MED组（2.18±0.38）多，差异有统计学意义（P＜0.05）；两组住院时间及住院费用无明显差异（P＞0.05）；末次随访改良MacNab标准评估疗效，VPTED组优17例，良3例，可1例，优良率为95.24%；MED组优22例，良4例，可2例，优良率为92.86%，两组优良率比较差异无统计学意义（P＞0.05）。结论：可视化椎间孔镜技术与显微内窥镜下椎间盘切除术治疗腰椎侧隐窝狭窄症近期疗效良好，是一种安全、有效的微创手术方式。

英文摘要:

  【Abstract】 Objectives: To compare the early curative effect of visualization of percutaneous transforaminal endoscopic discectomy(VPTED) and microendoscopic discectomy(MED) in the treatment of lumbar spinal stenosis． Methods: 49 patients with single segmental lumbar spinal stenosis combined with lumbar disc herniation(LDH) were treated in our hospital from March 2016 to March 2017. Among them, 21 cases accepted VPTED, and 28 cases underwent MED． The length of incision, amount of bleeding during operation, operation time, length of hospital stay and the cost of hospitalization were recorded in the both groups． Visual analogue scale(VAS) was used to evaluate the effect of surgery, Oswestry disability index(ODI) was used to evaluate the clinical efficacy． The modified MacNab criteria were used to evaluate the efficacy of the patients at final follow-up. Results: There were no statistical differences among the age, the ratio of male to female, follow-up time, low back pain, weakness, sensory disturbance, general reflexes and prominent segments(P>0.05). There were statistically significant differences between the two groups in preoperative and postoperative VAS and ODI scores(P＜0.05). There was no significant difference in VAS or ODI score between groups at the same time(P＞0.05)． The length of incision(0.78±0.06cm vs 1.95±0.12cm), the amount of intraoperative perspective(15.86±2.66 vs 2.18±0.38) and the operation time(87.51±30.46min vs 47.53±13.61min) had significant difference between VPTED and MED group(P＜0.05)． There was no significant difference in hospitalization time or hospitalization expenses between the two groups(P＞0.05)． At final follow-up, based on the MacNab standard, it was excellent in 17 cases, good in 3 cases, fair in 1 case in VPTED group; it was excellent in 22 cases, good in 4 cases, fair in 2 cases in MED group. Excellent rate of the VPTED group was 95.24%, and that was 92.86% in the MED group, there was no significant difference between the two groups(P>0.05). Conclusions: Visualization of percutaneous transforaminal endoscopic discectomy(VPTED) and microendoscopic discectomy(MED) in the treatment of lumbar spinal stenosis have good short-term curative effect, it iproves that VPTED is a safe and effective minimally invasive surgery．