微创单孔分体内镜技术联合经皮椎弓根螺钉术治疗多节段腰椎管狭窄症疗效分析

Clinical Efficacy Assessment of Single-Hole Split Endoscopy Integrated with Percutaneous Pedicle Screw Fixation for Multi-Segmental Lumbar Spinal Stenosis Treatment

目的本研究回顾性分析微创单孔分体内镜技术(one-hole split endoscope,OSE)联合经皮椎弓根螺钉术(percutaneous pedicle screw fixation,PPSF)治疗多节段腰椎管狭窄症(multi-segments lumbar spinal stenosis,MLSS)的临床疗效。方法回顾性分析2021年1月至2023年3月北京民航总医院收治的52例MLSS患者资料,伴有腰椎不稳行OSE减压融合联合PPSF术(OSE融合组),不伴有腰椎不稳行OSE单纯减压术(OSE减压组)。OSE融合组共30例,男10例,女20例;年龄51~82岁,平均(61.54±14.62)岁;OSE减压组共22例,男7例,女15例;年龄52~85岁,平均(62.37±15.23)岁;对比两组手术时间、术中透视次数、术中出血量、术后伤口引流量、术后住院时间和手术并发症。记录手术前后腰背部和腿疼痛视觉模拟评分(visual analogue scale,VAS)、Oswsetry功能障碍指数(Oswestry disability index,ODI)。影像学参数包括腰椎前凸角度(lumbar lordosis angle,LLA)和责任节段椎间隙高度(mean disc height,MDH)。结果患者均获随访,OSE融合组随访时间12~32个月,平均(18.36±9.45)个月;OSE减压组随访时间12~30个月,平均(17.94±10.23)个月。两组手术时间、术中透视次数、术中出血量、术后伤口引流量、术后住院时间比较差异有统计学意义(P<0.05)。两组术后1周和末次随访腰背部及下肢VAS评分和ODI均显著低于术前,差异有统计学意义(P<0.05)。OSE融合组术后1周和末次随访的MDH和LLA均显著高于术前,差异有统计学意义(P<0.05)。手术并发症共3例,均为OSE融合组患者:2例患者术后出现一过性神经损伤症状加重,考虑为术中牵扯神经根所致,术后给予小剂量激素、脱水及营养神经等治疗,并加强康复锻炼,症状逐渐缓解;1例患者发生术中硬膜撕裂,术中严密缝合撕裂口,术后头低脚高卧床,放置伤口引流管后好转。结论本研究的初步结果显示,OSE单纯减压术和OSE减压融合联合PPSF术,均可取得满意的临床疗效。OSE技术联合PPSF能够有效缓解MLSS患者的临床症状,具有术中创伤小、出血较少、术野清晰、操作灵活、术后恢复快等优点,需要严格把握适应证,根据MLSS患者的临床症状、体征和影像学检查来选择合适的手术方式,做到个体化精准微创治疗。

Objective To retrospectively analyzed the clinical efficacy of one-hole split endoscope(OSE)combined with percutaneous pedicle screw fixation(PPSF)in the treatment of multi-segments lumbar spinal stenosis(MLSS).Methods A retrospective cohort study was designed to evaluate the clinical outcomes of 52 patients undergoing surgical interventions for multi-segmental lumbar spinal stenosis(MLSS)at Beijing Civil Aviation General Hospital from January 2021 to March 2023.The OSE fusion Group(n=30),comprising patients with preoperative lumbar instability who underwent a combined one-hole split endoscopy(OSE)decompression and percutaneous pedicle screw fixation(PPSF)for fusion;and the OSE decompression Group(n=22),consisting of patients without preoperative lumbar instability who underwent OSE decompression alone.Demographic characteristics,including age and gender,were recorded.Comparative analyses were conducted for surgical parameters such as surgical duration,intraoperative blood loss,postoperative hospital stay,wound drainage volume,intraoperative fluoroscopy frequency,and surgical complications.Additionally,preoperative,1-week postoperative,and final follow-up assessments were made using the visual analogue scale(VAS)for lower back and leg pain,and the Oswestry Disability Index(ODI).Imaging parameters,namely lumbar lordosis angle(LLA)and mean disc height(MDH)of the affected segment,were also evaluated.Results All patients completed the follow-up period,with the OSE fusion group having a follow-up duration ranging from 12 to 32 months,averaging at(18.36±9.45)months,and the OSE decompression group being followed up for 12 to 30 months,averaging(17.94±10.23)months.Statistically significant differences(P<0.05)were observed between the two groups regarding surgical time,intraoperative blood loss,postoperative wound drainage volume,postoperative hospital stay,and intraoperative fluoroscopy frequency.One week postoperatively and at the final follow-up,both groups demonstrated significantly reduced VAS scores and ODI for back and lower limb pain compared to preoperative levels,with these differences being statistically significant(P<0.05).In the OSE fusion group,the MDH and LLA were significantly higher at 1 week and the last follow-up compared to preoperative values,displaying statistically significant differences(P<0.05).A total of 3 surgical complications occurred,all within the OSE fusion group.Two patients experienced transient exacerbation of nerve damage symptoms,attributed to intraoperative nerve root involvement.These patients underwent postoperative low-dose hormone therapy,dehydration treatment,nerve nutrition,and intensified rehabilitation exercises,resulting in gradual symptom improvement.Additionally,one patient experienced an intraoperative dural tear,which was immediately repaired during surgery.Postoperatively,the patient was instructed to remain bedridden with the head lower than the feet and a wound drainage tube was placed,leading to subsequent improvement.Conclusion The preliminary findings of this study suggest that both OSE decompression alone and the combined approach of OSE fusion with PPSF demonstrate promising clinical outcomes.Notably,the integration of OSE with PPSF effectively mitigates the clinical symptoms in patients with MLSS,showcasing advantages such as minimized intraoperative trauma,reduced blood loss,clear surgical visualization,procedural flexibility,and accelerated postoperative recovery.Hence,it is imperative to meticulously assess the indications and select the appropriate surgical approach tailored to the individual patient’s clinical presentation,signs,and imaging findings,thereby achieving personalized and precise minimally invasive treatment for MLSS.