Delta大通道椎板间镜技术治疗胸椎管狭窄症的临床研究

Clinical study on Delta percutaneous spinal endoscopy in the treatment of thoracic canal stenosis

目的:探讨Delta大通道椎板间镜技术治疗胸椎管狭窄症的手术疗效。方法:对2018年9月至2019年9月,我科采用Delta大通道椎板间镜技术治疗的15例胸椎管狭窄症患者的临床资料进行回顾性分析,记录手术时间、术中出血量、住院时间、疼痛视觉模拟评分(visual analogue scale,VAS)和日本骨科协会(Japanese orthopaedic association,JOA)评分等指标并进行统计分析。结果:本组病例手术时间70~102 min,平均(69.04±19.36)min;术中出血量25~55 mL,平均(36±6.21)mL;住院时间5~9天,平均(7.2±2.18)天。伤口愈合均良好,无脑脊液漏、硬膜外血肿、脊髓神经功能恶化、神经损伤和切口感染等并发症。均获3个月随访。术后1周和术后3个月VAS评分与术前比较显著改善,差异有统计学意义(P<0.05);JOA评分由术前的(8.63±1.31)分提升至术后1周的(12.81±1.18)分,改善率为(23.55±3.62)%,3个月随访为(15.63±1.31)分,改善率为(40.85±6.32)%,差异有统计学意义(P<0.05)。术后3个月15例恢复情况:优10例,良3例,可2例,优良率为86.67%。结论:Delta大通道椎板间镜技术治疗胸椎管狭窄症患者疗效显著,手术创伤小,术中出血少,术后恢复快,是临床上值得探索与研究的、有效的微创手术方式。

Objective:To investigate the curative effects and influencing factors of ossification of ligamentum flavum(OLF)treated by percutaneous spinal endoscopy.Methods:From September 2018 to September 2019,a total of 15 patients with thoracic canal stenosis caused by ossification of ligamentum flavum(OLF)treated with Delta percutaneous spinal endoscopy in our department with were retrospectively analyzed.To observe,record and statistically analyze the operation time,bleeding amount,hospital stay,visual analogue scale(VAS),and the Japan orthopaedic association(JOA)scores.Results:The operation time was 70~102 min,with an average of(69.04±19.36)min.Intraoperative blood loss was 25~55 mL,with an average of(36±6.21)mL.The length of hospitalization was 5~9 days,with an average(7.2±2.18)days.Wound healing was good,without cerebrospinal fluid leakage,epidural hematoma,deterioration of spinal nerve function,nerve injury,incision infection and other complications.All patients were followed up for 3 months.VAS score at 1 week and 3 months after surgery was significantly improved compared with that before surgery,with statistically significant difference(P<0.05).JOA score was increased from(8.63±1.31)preoperatively to(12.81±1.18)postoperative 1 week,the improvement rate was(23.55±3.62)%,JOA score was(15.63±1.31)at postoperative 3-month follow-up,the improvement rate was(40.85±6.32)%,the difference was statistically significant(P<0.05).The 15 cases recovered at postoperative 3-month follow-up:excellent 10,good 3,moderate 2,the excellent and good rate was 86.67%.Conclusion:Percutaneous spinal endoscopy is effective for patients with OLF of the thoracic vertebrae.The operation is less invasive with less bleeding,less complication,and quick recovery.It is really a new and effective method that is worth exploring and researching.