显微镜辅助与单纯应用Dynesys治疗腰椎管狭窄症的比较研究

A Comparison Study of Dynesys Dynamic Stabilization System for the Treatment of Lumbar Stenosis Between Under Microscope and Standard Method

目的比较显微镜辅助下应用Dynesys治疗腰椎管狭窄症与常规应用Dynesys的手术,探讨显微镜辅助手术的有效性和临床效果。方法分析2012年1月~2014年6月25例应用Dynesys系统治疗腰椎管狭窄症患者的临床资料,所有病例平均随访1.4年,其中12例采用显微镜辅助下应用Dynesys系统减压术,另13例采用标准Dynesys系统减压术。两种手术方式在手术时间、术中和术后出血量、术后下地时间及并发症等方面进行统计分析,并对所有病例进行术前和术后的神经学、影像学评估,比较减压效果。结果采用显微镜手术的12例患者,手术时间(120.5±25.0)min,术中出血量(396.61±165.492)m L,术后切口引流量(153±75.2)m L。视觉模拟评分法(VAS评分)术前7.43±1.8,末次随访1.7±1.5。采用标准手术的13例患者,平均手术时间(130.6±30.5)min。术中平均出血量(450.52±179.352)m L,平均术后切口引流量(250±90.6)m L。VAS评分术前7.50±1.5,末次随访1.70±1.4。两种手术方式在神经功能差异无统计学意义(P>0.05),但在时间及出血量差异有统计学意义(P<0.01)。结论显微外科技术辅助下应用Dynesys治疗腰椎管狭窄症中,术中显露充分,减压彻底,安全性高,出血量少,术后腰椎稳定性恢复好,效果佳。

Objective Comparison study of Dynesys dynamic stabilization system for the treatment of lumbar stenosis between under microscope and standard method retrospectively,investigate clinical result of surgery under microscope. Methods 25 patients with lumbar stenosis undergone surgery of Dynesys dynamic stabilization system were evaluated retrospectively from Jannuray 2012 to June 2014. 12 patients underwent operation under microscope; 13 patients underwent traditional operation. The operating time,bleeding volume during operating and poster operating,walking time postoperation and complication were observed. Clinical outcomes were assessed by Visal Analogue Score（ VAS）,Image of before and after operation. Results Microsurgery operating time average of（ 120. 5 ± 25. 0） mins,Bleeding volume during operation average of（ 396. 61 ± 165. 492） m L and after operation average of（ 153 ± 75. 2）m L. The VAS scores were changed from 7. 43 ± 1. 8 pre- operatively to 1. 7 ± 1. 5 in the final follow- up. Traditional operating time average of（ 130. 6 ± 30. 5） mins,Bleeding volume during operation average of（ 450. 52 ± 179. 352） m L and after operation average of（ 250 ± 90. 6） m L. The VAS scores were changed from 7. 50 ± 1. 5 pre- operatively to1. 70 ± 1. 4 in the final fellow- up. There were no difference between two groups（ P〉0. 05） in the VAS scores. Difference（ P〈0. 01） in bleeding volume and operating time. Conclusions The operation under microscope is restored significantly than the standard method in bleeding volume,the surgical field,safty of operation,time of recovery and so on.