经皮椎间孔镜治疗腰椎神经根孔狭窄的短期疗效观察

Short-term Effectiveness of Percutaneous Endoscopic Foraminotomy for Lumbar Intervertebral Foramen Stenosis

目的探讨经皮椎间孔镜治疗腰椎神经根孔狭窄的短期疗效。方法回顾性分析2012年1月~2015年6月因单侧单节段腰椎神经根孔狭窄手术治疗的42例资料,其中椎间孔镜组21例,经椎间孔椎体间融合术（transforaminal lumbar intervertebral fusion,TLIF）21例,2组术前下肢疼痛视觉模拟评分（visual analogue scale,VAS）、Oswestry功能障碍指数（Oswestry disability index,ODI）和腰椎日本骨科学会（Japanese Orthopaedic Association,JOA）评分差异无显著性（P〉0.05）。比较2组间及同组手术前和术后3个月下肢疼痛VAS评分、ODI评分、腰椎JOA评分差异。结果与TLIF组比较,椎间孔镜组出血量少[（94.3±67.7）ml vs.（371.4±164.8）ml,t=-7.130,P=0.000],住院时间短[（6.2±2.0）d vs.（10.5±2.9）d,t=-5.611,P=0.000],但手术时间长[（161.9±44.5）min vs.（111.7±28.0）min,t=4.375,P=0.000]。2组术后3个月下肢疼痛VAS评分、ODI评分、腰椎JOA评分均较术前明显改善（P〈0.05）,2组间差异无显著性（P〉0.05）。结论经皮椎间孔镜和TLIF在治疗神经根孔狭窄中均能得到良好的临床效果。经皮椎间孔镜术中出血量少,住院时间短,但手术时间长,可能与初期经验不足有关。

Objective To investigate the feasibility and short-term effectiveness of percutaneous endoscopic foraminotomy for lumbar intervertebral foramen stenosis. Methods A retrospective case-controlled analysis was made on 42 patients with unilateral single-level lumbar intervertebral foramen stenosis receiving either percutaneous endoscopic lumbar foraminotomy（ PELF,n = 21） or transforaminal lumbar interbody fusion（ TLIF,n = 21） between January 2012 and June 2015. All the patients were evaluated with general condition,leg pain visual analogue scores（ VAS）,Oswestry disability index（ ODI）,Japanese Orthopaedic Association（ JOA）scores,operation time,blood loss and length of stay. There were no significant differences in preoperative leg pain VAS,ODI and JOA scores between the two groups. Results As compared to the TLIF group,the PELF group had less blood loss [（ 94. 3 ± 67. 7） ml vs.（ 371. 4 ± 164. 8） ml,t =- 7. 130,P = 0. 000] and shorter length of stay [（ 6. 2 ± 2. 0） d vs.（ 10. 5 ± 2. 9） d,t =- 5. 611,P = 0. 000],but longer operation time [（ 161. 9 ± 44. 5） min vs.（ 111. 7 ± 28. 0） min,t = 4. 375,P = 0. 000]. After 3 months postoperatively,both groups had significant improvement in the VAS scores,ODI scores,and JOA scores as compared with those of preoperation（ P〈0. 05）. There was no statistical difference between the two groups（ P〉0. 05）. Conclusions Satisfactory clinical outcomes can be achieved in both PELF and TLIF for lumbar intervertebral foramen stenosis. PELF is characterized with less blood loss and shorter length of stay but longer operation time which may be due to lack of experience.