经皮全脊柱内镜与显微镜辅助下经椎板间隙入路手术对老年腰椎管狭窄症的疗效及安全性分析

Efficacy and safety of translaminar approach surgery assisted by percutaneous total spinal endoscopy and microscope for elderly patients with lumbar spinal stenosis

目的比较经皮全脊柱内镜与显微镜辅助下经椎板间隙入路手术对老年腰椎管狭窄症患者炎性氧化应激及椎旁肌形态的影响。方法选取我院老年腰椎管狭窄症患者98例,根据手术方案分为经皮内镜组和显微镜组,每组49例,分别行经皮全脊柱内镜辅助下经椎板间隙入路手术和显微镜辅助下经椎板间隙入路手术。统计2组围术期指标、并发症情况;比较2组手术前后炎性氧化应激指标氧化蛋白产物(AOPP)、丙二醛(MDA)、肿瘤坏死因子-α(TNF-α)水平、视觉模拟量表(VAS)评分、日本骨科协会评估治疗(JOA)评分、影像学指标椎间隙前后缘高度(ISH)、椎间盘高度(DH)、手术节段活动范围(ROM)及椎旁肌形态(多裂肌功能横截面积、腰肌相对截面积、多裂肌脂肪沉积等级)。结果经皮内镜组手术时间、术后下床时间、住院时间短于显微镜组(P<0.05)。术后3 d经皮内镜组血清AOPP、MDA、TNF-α水平低于显微镜组(P<0.05)。术后1周经皮内镜组VAS评分低于显微镜组(P<0.05)。手术前后2组JOA评分比较差异无统计学意义(P>0.05)。与术前比较,术后3个月2组患者ISH、DH较小(P<0.05),ROM较大(P<0.05)。术后3个月,经皮内镜组多裂肌功能横截面积大于显微镜组(P<0.05),腰肌相对截面积、多裂肌脂肪沉积等级小于显微镜组(P<0.05)。2组并发症发生率比较,差异无统计学意义(P>0.05)。结论与显微镜辅助下经椎板间隙入路手术比较,经皮全脊柱内镜辅助下经椎板间隙入路手术治疗老年腰椎管狭窄症,整体效果更为理想,可缩短手术时间,减轻机体创伤,促进术后恢复,缓解疼痛,提升腰椎功能,调整结构状态的同时能够维护椎旁肌形态,且安全性良好。

Objective To compare the effects of translaminar approach surgery assisted by percutaneous total spinal endoscopy and microscope on the inflammatory oxidative stress and paraspinal muscle morphology in elderly patients with lumbar spinal stenosis.MethodsA total of 98 elderly patients with lumbar spinal stenosis in our hospital were selected and divided into the percutaneous endoscopy group and the microscope group according to the surgical plan,with 49 cases in each group.They were treated with percutaneous total spinal endoscopy-assisted translaminar approach surgery and microscope-assisted translaminar approach surgery,respectively.The perioperative indicators and complications of the two groups were counted.The levels of inflammatory oxidative stress indicators[advanced oxidation protein products(AOPP),malondialdehyde(MDA),and tumor necrosis factor-α(TNF-α)],visual analogue scale(VAS)scores,the Japanese Orthopaedic Association(JOA)scores,imaging indicators[intervertebral space height(ISH),intervertebral disc height(DH),and range of motion(ROM) of the surgical segment]and the paraspinal muscle morphology(functional cross-sectional area of multifidus muscle,relative cross-sectional area of psoas muscle,and fat deposition grade of multifidus muscle)of the two groups before and after operation were compared.ResultsThe operation time,postoperative time to get out of bed,and hospital stay in the percutaneous endoscopy group were shorter than those in the microscope group(P<0.05).The levels of serum AOPP,MDA and TNF-α3 days after operation in the percutaneous endoscopy group were lower than those in the microscope group(P<0.05).The VAS score 1 week after operation of the percutaneous endoscopy group was lower than that of the microscope group(P<0.05).There was no statistically significant difference in the JOA scores between the two groups before and after operation(P>0.05).Compared with those before operation,the ISH and DH 3 months after operation of patients in the two groups were smaller,and the ROM was larger(P<0.05).The functional cross-sectional area of multifidus muscle 3 months after operation in the percutaneous endoscopy group was larger than that in the microscope group,and the relative cross-sectional area of psoas muscle and fat deposition grade of multifidus muscle were samller than those in the microscope group(P<0.05).There was no statistically significant difference in the incidence of complications between the two groups(P>0.05).Conclusion Compared with the microscope-assisted translaminar approach surgery,percutaneous total spinal endoscopy-assisted translaminar approach surgery for elderly lumbar spinal stenosis has more ideal overall effect.It can shorten the operation time,reduce body trauma,promote postoperative recovery,alleviate pain,improve the lumbar spinal function,adjust the structural state and maintain the paraspinal muscle morphology,with good safety.