内镜下保留棘突韧带复合体治疗腰椎退行性疾病的效果

Effect of endoscopic preservation of spinous process ligament complex on lumbar degenerative disease

目的探讨内镜下保留棘突韧带复合体治疗腰椎退行性疾病的临床疗效。方法选择2016年9月至2017年9月郑州大学第一附属医院骨科五病区收治的100例单节段腰椎退行性疾病患者,采用随机数表法分为对照组和观察组,每组50例。对照组行传统后路椎间融合术(PLIF),观察组行内镜下保留棘突韧带复合体的后正中小切口椎间融合术。比较两组患者的手术失血量、切口长度、手术耗时、术后卧床时间;采用视觉疼痛模拟评分(VAS)、Oswestry功能障碍指数(ODI)评分对两组患者的手术疗效进行比较。结果与对照组相比较,观察组的手术失血量小、切口短、手术用时短及术后卧床时间短,术后1周、3个月的VAS评分、ODI评分低,差异有统计学意义(P<0.05)。但两组术后6个月的VAS评分及ODI评分比较,差异未见统计学意义(P>0.05)。两组患者椎间融合率比较,差异未见统计学意义(P>0.05)。结论内镜下保留棘突韧带复合体的后正中小切口椎间融合术,手术创伤小,术后恢复快,临床效果好,是治疗腰椎退行性疾病的一种有效的新方法。

Objective To investigate the clinical efficacy of preservation of spinous process ligament complex under endoscope on lumbar degenerative diseases.Methods One hundred patients with single-segment lumbar degenerative disease admitted to the Department of Orthopaedics of the First Affiliated Hospital of Zhengzhou University from September 2016 to September 2017 were randomly divided into the control group and the observation group,with 50 cases in each group.The patients in the control group underwent traditional posterior lumbar interbody fusion(PLIF),and the patients in the observation group underwent posterior median small incision interbody fusion with endoscopic preservation of the spinous process ligament complex.The incision length,intraoperative blood loss,operation time,and bed rest time were compared between the two groups.The surgical outcomes of the two groups were compared using visual analogue scale(VAS)and Oswestry dability index(ODI)scores.Results Compared with the control group,the intraoperative blood loss and the surgical incision was smaller in the observation group,and the operation time and postoperative bed time were shorter;the VAS score and ODI score were lower 1 week and 3 months after operation,and the differences were significant(P<0.05).However,there was no significant difference in VAS score and ODI score between the two groups 6 months after surgery(P>0.05).There was no significant difference in the rate of intervertebral fusion between the two groups(P>0.05).Conclusions Endoscopic preservation of the spinous process ligament complex is a new minimally invasive method for the treatment of lumbar degenerative diseases with rapid postoperative recovery and good clinical efficacy.