经皮椎间孔镜下选择性减压与切开减压内固定术治疗老年性腰椎管狭窄的临床分析

Clinical analysis of percutaneous transforaminal endoscopic selective decompression and open reduction internal fixation for senile lumbar spinal stenosis

目的探究经皮椎间孔镜下选择性减压与切开减压内固定术在老年性腰椎管狭窄中的临床治疗效果。方法选择2015年7月至2016年12月惠州市第三人民医院收治的老年性腰椎管狭窄患者86例,其中男性53例,女性33例;年龄60~78岁。按照患者选取手术方式不同将其分为经皮椎间孔镜组(TESSYS组,36例)和传统手术组(TS组,50例),其中TESSYS组患者采用经皮椎间孔镜下选择性减压术治疗,TS组患者采用切开减压内固定术治疗。统计两组患者手术时间、切口长度、术中出血量、住院时间及术后并发症等,评估两组患者术前、出院时、术后1个月、术后3个月、术后6个月及术后12个月时Oswestry功能障碍指数(ODI)、视觉模拟量表(VAS)评分及改良MacNab疗效评定,比较两组患者围手术指标及临床疗效。结果 TESSYS组患者手术时间、切口长度、术中出血量、住院时间及术后并发症发病率明显优于TS组,差异具有统计学意义(P <0.05)。TESSYS组手术优良率(94.44%)明显优于TS组(84.00%),差异具有统计学意义(P <0.05)。两组患者术后不同时间段的VAS评分、ODI评分均优于术前[VAS评分,TESSYS组术后12个月(1.43±0.38)分vs (7.45±1.54)分,TS组术后12个月(1.81±0.49)分vs (7.42±1.12)分;ODI评分,TESSYS组术后12个月(6.34±4.08)分vs (65.84±13.89)分,TS组术后12个月(9.75±3.78)分vs (64.87±14.28)分],且呈逐渐好转趋势,差异具有统计意义(P <0.05);两组术前患者VAS评分、ODI评分比较,差异无统计学意义(P> 0.05);TESSYS组术后各时间段VAS评分、ODI评分均优于TS组,差异具有统计学意义(P <0.05)。TESSYS组术后并发症发生率(2.78%)小于TS组术后(12.00%),差异有统计学意义(P <0.05)。结论经皮椎间孔镜下选择性减压治疗老年性腰椎管狭窄在手术时间、切口长度、术中出血量、住院时间、术后并发症等方面具有明显优势,并且对脊柱稳定性影响较小,症状改善明显,术后恢复较快,疗效确切。但其手术视野有限,对施术者操作性要求较高,需要严格把握手术适应证。

Objective To explore the clinical efficacy of percutaneous transforaminal endoscopic selective decompression and open reduction internal fixation in the treatment of senile lumbar spinal stenosis. Methods From July 2015 to December2016, a total of 86 patients with spinal stenosis were enrolled, which included 53 males and 33 females, aged 60-78 years old. According to surgical approach, patients were divided into percutaneous transforaminal group（n = 36, performed percutaneous transforaminal decompression, TESSYS group） and traditional operation group（n = 50, performed open decompression internal fixation, TS group）. The operation time, incision length, intraoperative bleeding, hospitalization and postoperative com-plications were recorded. The oswestry disability index（ODI）, visual analogue scale（VAS）, efficacy evaluation of improved MacNab of 1-month, 3-month, 6-month and 12-month after operation were evaluated. Perioperative indexes and clinical curative effect were compared between 2 groups. Results The operation time, incision length, intraoperative bleeding, hospitalization and postoperative complication of TESSYS group were statistically significantly better than those of TS group, the difference was statistically significant（P〈0.05）. The VAS score and ODI score in different operation times of 2 groups were statistical-ly significant better than those before operation[VAS, after operation 12-month of TESSYS group was（1.43 ± 0.38） scores vs（7.45 ± 1.54） scores, after operation 12-month of TS group was（1.81 ± 0.49） scores vs（7.42 ± 1.12） scores; ODI, after operation 12-month of TESSYS group was（6.34 ± 4.08） scores vs（65.84 ± 13.89） scores, after operation 12-month of TS group was（9.75 ± 3.78） scores vs（64.87 ± 14.28） scores], which were better than before operation, and the differences were statistically significant（P〈0.05）; The VAS scores and ODI scores before operation were no significant differences between 2 groups（P〈0.05）;The VAS score and ODI score of TESSYS group were statistically significant better than those of TS group, which were better than before operation. The postoperative complication rate in TESSYS group（2.78 %） was statistically significant lower than in TS group（12.00 %）, and the differences was statistically significant（P〈0.05）. Conclusion It is demonstrated that compared with traditional operation, percutaneous transforaminal endoscopic selective decompression for senile lumbar spinal stenosis showed obvious advantages in operation time, incision length, intraoperative bleeding, hospitalization and postoperative complications, which with improvement symptoms, faster recovery and definite therapeutic effect and little effect on spine stability.However, the strict control of surgical indications is required for its limited surgical vision and high operational requirements.