单侧入路显微内镜椎管减压术治疗腰椎管狭窄症

MICROENDOSCOPIC DECOMPRESSION VIA UNILATERAL APPROACH FOR LUMBAR SPINAL STENOSIS

目的采用前瞻性对比研究评价单侧入路显微内镜椎管减压术治疗腰椎管狭窄症的安全性及疗效。方法 2006年5月-2009年6月,收治79例椎管狭窄症患者,随机分为两组:A组37例采用常规后路开窗减压术,B组42例采用单侧入路显微内镜椎管减压术治疗。两组患者性别、年龄、病程、狭窄节段等一般资料比较差异无统计学意义(P>0.05),具有可比性。采用疼痛视觉模拟评分(VAS)及Oswestry功能障碍指数(ODI)比较两组患者术后症状缓解情况,使用ODI改善率评定手术临床疗效,并对两组手术时间、术中出血量以及围手术期并发症进行对比。结果两组均顺利完成手术,A组手术时间(75.0±25.7)min,术中出血量(140.3±54.8)mL,术后引流量(46.5±19.7)mL;B组分别为(50.4±18.2)min、(80.2±35.7)mL、(12.7±5.3)mL;两组比较差异均有统计学意义(P<0.05)。两组患者切口均Ⅰ期愈合。79例均获随访,随访时间12～39个月,平均16个月。A组5例发生并发症,1例为椎间隙感染,经保守治疗后痊愈;4例为术后腰椎不稳,经腰椎间融合联合脊柱内固定治愈。B组2例发生并发症,均为镜下硬膜小孔样撕裂脑脊液漏,行相应处理后治愈;随访时未发现腰椎不稳。两组术前VAS评分及ODI比较差异均无统计学意义(P>0.05);术后早期及末次随访时较术前均有明显改善(P<0.05)。B组术后24 h的VAS评分及术后1个月的ODI均较A组降低(P<0.05),末次随访时两组间差异无统计学意义(P>0.05)。末次随访时根据ODI改善率得出的手术临床效果,A组优良率为89.2%,B组为92.9%,两组比较差异无统计学意义(χ2=0.896,P=0.827)。结论相比后路开放手术,单侧入路显微内镜椎管减压术手术损伤小、术后恢复好,具有更好的早期临床效果,是治疗腰椎管狭窄的有效方法之一。

Objective To investigate the effectiveness and safety of microendoscopic decompression via unilateral approach for lumbar spinal stenosis.Methods Between May 2006 and June 2009,79 patients with lumbar stenosis were treated and divided into 2 groups： posterior lamina fenestration decompression（group A,n=37）,endoscopic decompression via unilateral approach（group B,n=42）.There was no significant difference in age,sex,segment level,and disease duration between 2 groups（P〉 0.05）.The clinical outcomes were assessed by using the visual analogue scale（VAS） score and Oswestry Disability Index（ODI）.The operation time,blood loss,complications were compared between 2 groups.Results Operations were successfully performed in all cases.The operation time,blood loss,and drainage volume were（75.0 ± 25.7） minutes,（140.3 ± 54.8） mL,and（46.5 ± 19.7） mL in group A,were（50.4 ± 18.2） minutes,（80.2 ± 35.7） mL,and（12.7 ± 5.3） mL in group B;there were significant differences between 2 groups（P 〈0.05）.All the wounds healed by first intention.All patients were followed up 12-39 months（mean,16 months）.In group A,1 patient suffered from intervertebral space infection after operation and recovered after conservative treatment;4 patients had lumbar instability after operation and recovered after lumbar interbody fusion combined with spine system internal fixation.In group B,2 patients suffered from spinal dural rupture during operation and recovered after corresponding treatment,and no lumbar instability was found.There was no significant difference in VAS score and ODI between 2 groups at preoperation（P〉 0.05）.Both VAS score and ODI were significantly improved at early stage after operation and last follow-up when compared with preoperation in each group（P〈 0.05）.Comparing with group A,there was significant improvement in VAS score at 24 hours postoperatively and in ODI at 1 month postoperatively in group B（P〈 0.05）,but no significant difference was observed at last follow-up（P〉 0.05）.According to clinical evaluation of ODI improvement rate,the excellent and good rate was 89.2% in group A and 92.9% in group B,showing no significant difference（χ2=0.896,P=0.827）.Conclusion Comparing with posterior decompression surgery,microendoscopic decompression via unilateral approach is one of effective method to treat lumbar stenosis,with less trauma of fenestration yield and good early outcomes.