改良经椎板间入路经皮内窥镜下减压术治疗退行性腰椎椎管狭窄

Modified percutaneous endoscopic interlaminar decompression for treatment of degenerative lumbar spinal stenosis

目的观察改良经椎板间入路经皮内窥镜下减压术(PEID)治疗退行性腰椎椎管狭窄症(DLSS)的临床效果,为此项技术在临床推广使用提供依据。方法 2013年6月—2015年6月,共74例符合纳入标准的DLSS患者纳入研究,其中男40例,女34例;随机将患者分为传统手术组(传统组)和改良PEID组(改良组),每组各37例。记录2组患者住院天数、手术时间、术中出血量、中央椎管矢径和横径的变化,以及术前、术后3 d、术后3个月、术后6个月疼痛视觉模拟量表(VAS)评分和Oswestry功能障碍指数(ODI),以评估手术效果。结果所有手术顺利完成,所有患者随访>6个月。在住院天数、术中出血量方面,改良组优于传统组,差异有统计学意义(P<0.05)。2组患者术后3、6个月时VAS评分和ODI均较术前明显改善,差异有统计学意义(P<0.05);但2组间各时间点VAS评分和ODI改善差异无统计学意义(P>0.05)。结论改良PEID可以取得与开放减压术同样的临床效果。且改良PEID在住院天数、术中出血量等方面明显优于传统开放减压术,提示它是治疗DLSS的安全有效的手术方法。

Objective To observe the surgical results of modified percutaneous endoscopic interlaminar decompression(PEID) for treatment of degenerative lumbar spinal stenosis(DLSS) to provide basis for popularization of PEID. Methods From June 2013 to June 2015,a total of 74 patients(40 males and 34 females) was brought into the research for degenerative lumbar spinal canal stnosis. Patients were randomly divided into the modified PEID group(modify group) and conventional laminectomy decompression group(convention group),37 in each group. The primary outcome measures included hospital stay,operation time,blood loss,change in sagittal and transverse diameter of the central canal,and also visual analogue scale(VAS) score,Oswestry disability index(ODI) at pre-operation,postoperative 3 d,postoperative 3 months and postoperative 6 months,which were used to evaluate the surgical outcome. Results All the operations were completed successfully,and all the patients were followed up for > 6 months. In the hospital stay,blood loss of the modify group was less than that of the convention group,and the difference was statistically significant. Both groups had significant improvement of VAS score and ODI compared with pre-operation,and the improvement was similar between the 2 groups(P > 0.05). Conclusion The modified PEID has the same therapeutic effect with conventional laminectomy decompression,but has its advantages over open decompression in hospital stay and blood loss. So it is a safe and effective surgical option to treat DLSS.