传统后路椎管减压融合术与电子显微镜下微创术治疗退变性腰椎管狭窄症的疗效比较

Comparison of the efficacy of traditional posterior spinal decompression fusion and electron microscopy in minimally invasive surgery for degenerative lumbar spinal stenosis

目的对退变性腰椎管狭窄症患者在电子显微镜下行微创后路椎管减压融合术治疗,并与传统后路椎管减压融合术的临床治疗效果进行比较。方法选择2017年3月至2019年3月在本院行融合手术治疗的110例退变性腰椎管狭窄症患者作为研究对象,将采用电子显微镜导航行微创后路椎管减压融合术患者58例作为微创组,采用传统后路椎管减压融合术患者52例为传统组。对两组患者的手术指标、术后住院时间、术后并发症、视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)评分等进行比较分析,并采用MacNab标准于术后末次随访对两组临床效果进行评价。结果较之于传统手术组,微创组的手术时间、术中出血量、手术切口长度、术后住院时间、术后并发症均明显更短或更少,组间差异有统计学意义(P<0.05)。较之于治疗前,两组治疗后VAS评分与ODI评分明显改善(P<0.05),但治疗后两组间VAS评分与ODI评分比较差异无统计学意义(P>0.05)。两组患者末次随访优良率相比差异无统计学意义(P>0.05)。结论相较于传统减压融合术,电子显微镜导航下微创后入路椎管减压融合术治疗退变性腰椎管狭窄症在保证疗效的同时,还具有创伤小、出血量少、手术时间及住院时间短、术后并发症低等诸多优势,值得临床优先选择。

Objective The treatment of degenerative lumbar spinal stenosis by minimally invasive posterior spinal decompression and fusion under electron microscope was compared with that of traditional posterior spinal decompression and fusion.Methods A total of 110 patients with degenerative lumbar spinal stenosis who underwent fusion surgery in our hospital from March 2017 to March 2019 were selected.There were 58 patients who underwent minimally invasive posterior spinal decompression and fusion guided by electron microscope and selected as the minimally invasive group,Other 52 patients who underwent traditional posterior spinal decompression and fusion were selected as the traditional group.The surgical indicators,postoperative hospital stay,postoperative complica⁃tions,visual analog score(VAS)and Oswestry dysfunction index(ODI)scores of the two groups were compared and analyzed.The MacNab standard was used at the last postoperative period of follow⁃up to evaluate the clinical effects.Results Compared with traditional operation group,the operation time,intraoperative blood loss,surgi⁃cal incision length,postoperative hospital stay,and postoperative complications of the minimally invasive group were significantly shorter or less(P<0.05).The VAS score and ODI score of the two groups were all significantly improved after treatment(P<0.05)but there was no significant difference in VAS score and ODI score between two groups(P>0.05).Conclusion Compared with traditional decompression and fusion,electron microscope⁃guided minimally invasive posterior approach decompression and fusion not only guarantees the curative effect but also has many advantages for the treatment of degenerative lumbar spinal stenosis.The advantages includes less trauma,less bleeding,shorter operative time and hospital stay,and lower postoperative complications.It is worthy of clinical preference.