经皮椎间孔镜治疗老年性腰椎管狭窄症的疗效和安全性观察

Percutaneous Intervertebral Foramen Mirror For the Treatment of Denile Lumbar Spinal Stenosis Disease Curative Effect and Safety of Observation

目的系统观察经皮椎间孔镜治疗老年性腰椎管狭窄症的疗效及安全性,为临床合理治疗提供可借鉴的研究依据。方法设计实施小样本随机对照实验,将纳入研究的老年性腰椎管狭窄症患者96例按信封法分为两组(孔镜组及开放术式组),每组48例。孔镜组通过经皮椎间孔镜下髓核摘除技术实施治疗,开放术式组则采用传统开放手术减压并后路椎体间融合术治疗,严密观察比较两组术中及术后情况,并以视觉模拟评分法(VAS)、Oswestry功能障碍指数(ODI)评分法对两组中近期疗效进行评价。结果与开放术式组比较,孔镜组手术时间、出血量、住院时间等指标降低明显(P<0.05),术后12、24、48、72 h各观察时点的VAS评分也有不同程度降低(P<0.05),ODI指数评价显示,孔镜组术后6、12个月时日常生活能力的改善也优于开放术式组(P<0.05)。结论与传统开放术式相比,经皮椎间孔镜技术具有明显的微创优越性,疗效确切、安全性高,是一种较成熟有效的腰椎椎管狭窄治疗术式。

Objective System to observe the percutaneous intervertebral foramen mirror for the treatment of senile lumbar spinal stenosis disease curative effect and security, rational treatment for clinical provides the ba- sis of the research can be drawn lessons from. Design implementation of randomized controlled trials, small sam- ple size will be included in the study of senile patients with lumbar spinal stenosis disease in 96 cases by the enve- lope method is divided into two groups （hole mirror and open operation group）, 48 cases in each group. Aperture lens group by percutaneous intervertebral foramen mirror treatment, removal of nucleus pulposus under open surgery group with traditional open surgery decompression and fusion between the posterior vertebral body treat- ment, close observation comparison of intraoperative and postoperative conditions of two groups, and by the method of visual analogue scale （VAS） and Oswestry disability index （ODI） evaluation method to evaluate the recent curative effect in two groups. Results Compared with open surgery group, aperture lens group indices such as operation time, blood loss, hospital stay, reduced significantly（P〈 0.05）, 12, 24, 48, 72 h after each ob- servation point of VAS score also have varying degrees of lower（P 〈 0.05）, ODI index evaluation, according to the aperture lens set is 6 months and 12 months after the improvement of the daily life ability is better than open surgery group（P 〈 0.05）. Conclusion Compared with the traditional open surgery, percutaneous intervertebral foramen lens technology has obvious advantages of minimally invasive, curative effect, high safety, is a mature and effective lumbar spinal canal stenosis surgery treatment.