椎间孔镜治疗退行性腰椎管狭窄的临床疗效及其对腰椎功能评分的影响

Clinical Efficacy of Transforaminal Endoscopy in Treatment of Degenerative Lumbar Spinal Stenosis and Its Effect on Lumbar Functional Score

目的探讨椎间孔镜治疗退行性腰椎管狭窄(DLSS)的临床疗效及其对腰椎功能评分的影响。方法回顾性分析2016年5月至2017年5月安徽省皖南康复医院骨科收治的98例DLSS患者的临床及随访资料,根据手术方式不同分为观察组(n=50)和对照组(n=48),观察组采用椎间孔镜下椎间盘髓核摘除术+椎管扩大成形术+神经根松解术,对照组采用传统开放椎板切除减压术+椎管扩大成形术+椎间盘髓核摘除术+椎间植骨融合内固定术。比较两组患者手术情况、临床疗效以及手术前后视觉模拟评分(VAS)、Qswestry功能障碍指数(ODI)、日本骨科协会(JOA)评分、Lehmann腰椎功能评分。结果观察组手术时间长于对照组[(1.4±0.4)h比(1.1±0.3)h](P<0.01),卧床时间和住院时间短于对照组[(2.1±0.5)d比(4.2±0.7)d,(5.8±1.5)d比(10.6±3.1)d](P<0.01),术中出血量少于对照组[(48.5±14.2)mL比(240.6±57.6)mL](P<0.01),术后并发症发生率明显低于对照组[8.0%(4/50)比27.1%(13/48)](P<0.05)。观察组治疗总有效率高于对照组[94.0%(47/50)比81.2%(39/48)](P<0.05)。术后观察组VAS评分、ODI指数明显低于对照组,而JOA、Lehmann腰椎功能评分明显高于对照组(P<0.05)。结论采用微创椎间孔镜技术治疗DLSS,可准确摘除病变腰椎髓核,快速、彻底地减压、松懈神经根,缓解腰腿疼痛,提高临床疗效,恢复患者腰椎功能。

Objective To investigate the clinical efficacy of transforaminal endoscopy in the treatment of degenerative lumbar spinal stenosis(DLSS)and its effect on lumbar functional score.Methods The clinical and follow-up data of 98 DLSS patients admitted to Department of Orthopedics,South Anhui Rehabilitation Hospital from May 2016 to May 2017 were retrospectively analyzed.The patients were divided into a observation group(50 cases)and a control group(48 cases)according to the different operation methods.The observation group was treated with percutaneous transforaminal endoscopic discectomy plus enlarged laminoplasty plus nerve root lysis,while the control group was treated with traditional open laminectomy and decompression plus enlarged laminoplasty plus discectomy of nucleus pulposus plus interbody fusion and internal fixation.The operation condition and clinical effect,visual analogue score(VAS),Oswestry dysfunction index(ODI),Japanese Orthopedic Association(JOA)and Lehmann lumbar function score before and after surgery of the two groups were compared between the two groups.Results The operation time of the observation group was significantly longer than that of the control group[(1.4±0.4)h vs(1.1±0.3)h](P<0.01),while the bed time and hospitalization time of the observation group were shorter than those of the control group[(2.1±0.5)d vs(4.2±0.7)d,(5.8±1.5)d vs(10.6±3.1)d](P<0.01),and the amount of bleeding in the observation group was less than that of the control group[(48.5±14.2)mL vs(240.6±57.6)mL](P<0.01),the incidence of postoperative complications in the observation group was significantly lower than that in the control group[8.0%(4/50)vs 27.1%(13/48)](P<0.05).The total effective rate in the observation group was higher than that in the control group[94.0%(47/50)vs 81.2%(39/48)](P<0.05).The VAS score and ODI index in the observation group were significantly lower,while JOA and Lehamn lumbar function score were higher than those in the control group(P<0.05).Conclusion The treatment of DLSS by minimally-invasive transforaminal endoscopy can accurately remove the nucleus pulposus of the affected lumbar spine,quickly and thoroughly decompress and relax nerve roots,alleviate lumbar and leg pain,improve the clinical efficacy and restore lumbar spine function.