超声骨刀辅助通道下单侧开窗减压治疗腰椎管狭窄症的安全性及有效性分析

Efficacy analysis of the safety and effectiveness of unilateral fenestration decompression under ultrasound osteotome-assisted channel against lumbar spinal stenosis

目的研究超声骨刀辅助通道下单侧开窗减压治疗退行性腰椎管狭窄症的安全性及临床疗效。方法纳入2018年6月~2019年6月本院诊治的32例腰椎管狭窄症患者,分为采用超声骨刀辅助通道下单侧开窗减压治疗的超声骨刀组16例,采用电动磨钻辅助通道下单侧开窗减压治疗的传统减压组16例。统计有关手术观察指标:椎板减压时间、术中出血量等,根据VAS(Visual analogue scale)和ODI(The Oswestry disability index)评定手术效果,应用t检验进行统计学分析。结果32例均获随访,两组患者椎板减压时间、术中出血量比较,差异有统计学意义(P<0.05)。两组手术患者均未出现神经根损伤、硬脊膜撕裂等相关并发症。两组术后各时间点VAS评分比较,差异均有统计学意义(P<0.05)。超声骨刀组:术前与术后3 d VAS评分比较,差异有统计学意义(t=22.213,P=0.001);术前与术后3个月VAS评分比较,差异有统计学意义(t=21.742,P=0.002);术后3 d与术后3月VAS评分比较,差异无统计学意义(t=-0.382,P=0.452)。传统减压组:术前与术后3 d VAS评分比较,差异有统计学意义(t=24.693,P=0.046);术前与术后3个月VAS评分比较,差异有统计学意义(t=25.607,P=0.020);术后3 d与术后3个月VAS评分比较,差异无统计学意义(t=0.713,P=0.200)。两组术后ODI评分比较,差异均有统计学意义(P<0.05)。超声骨刀组:术前与术后3 d ODI评分比较,差异有统计学意义(t=24.536,P=0.044);传统减压组:术前与术后3 d ODI评分比较,差异有统计学意义(t=32.183,P=0.009)。结论超声骨刀辅助通道下单侧开窗减压术作为微创手术,创伤小、减压充分,对脊柱稳定性影响小,无需内固定,大大缩短手术时间,并且术中出血较少、术后疼痛轻、恢复快,具有明显的临床优势,值得临床推广。

Objective To study the safety and clinical efficacy of unilateral fenestration decompression under ultrasound osteotome-assisted channel against degenerative lumbar spinal stenosis.Methods 32 cases of lumbar spinal stenosis(LSS)diagnosed and treated from June 2018 to June 2019 were included,with 16 cases being treated with unilateral fenestration decompression under ultrasound osteotome-assisted channel,and another 16 cases being treated with unilateral fenestration decompression under electric drill bit sharpener-assisted channel.The changes of the operative observation indexes such as laminectomy decompression time and intraoperative blood loss,etc.were counted,the operative effect was assessed according to visual analogy scale(VAS)and the oswestry disability index(ODI),and t test was used for statistical analysis.Results 32 cases of patients were all followed up,and the difference in laminectomy decompression time and in intraoperative blood loss between the two groups was significant(P<0.05).No nerve root injury,dural laceration and other related complications occurred to the two groups of operative patients.There were statistically significant differences in VAS scores of the two groups at different time points after operation(P<0.05).In the ultrasound osteotome group:there was statistically significant difference in the VAS scores before and 3 d after operation(t=22.213,P=0.001);there was statistically significant difference in VAS scores before and 3 m after operation(t=21.742,P=0.002);there was no statistically significant difference in VAS scores 3 d and 3 m after operation(t=-0.382,P=0.452).In the traditional decompression group:there was statistically significant difference in the VAS scores before and 3 d after operation(t=24.693,P=0.046);there was statistically significant difference in VAS scores before and 3 m after operation(t=25.607,P=0.020);there was no statistically(t=0.713,P=0.200).There were statistically significant differences in the ODI scores of the two groups after operation(P<0.05).In the ultrasound osteotome group:there was statistically significant difference in the ODI scores before and 3 d after operation(t=24.536,P=0.044).In the traditional decompression group:there was statistically significant difference in the ODI scores before and 3 d after operation(t=32.183,P=0.009).Conclusion As a minimally invasive surgery(MIS),unilateral fenestration decompression under ultrasound osteotome-assisted channel incurs less trauma,has sufficient decompression,exerting little influence on spinal stability.With no need for internal fixation,operation time is greatly shortened.There is less intraoperative hemorrhage,less postoperative pain,and faster recovery.With obvious clinical advantages,it is worthy of clinical promotion.