两种入路内镜减压腰神经根管狭窄症近期比较

Comparison of short-term outcomes of endoscopic decompression through transforaminal versus interlaminar approaches for lumbar nerve root canal stenosis

[目的]比较经椎间入路内镜治疗腰神经根管狭窄症的早期临床效果。[方法]2017年1月~2019年5月,80例腰神经根管狭窄症患者纳入本研究,依据随机数字表法分为两组。其中40例采用经椎间孔内镜减压,40例采用经椎板间入路减压。比较两组围手术期、近期随访和影像资料。[结果]两组术中均未发生严重并发症,虽然经椎间孔组建立通道时间显著长于经椎板间组(P<0.05),但是经椎板间组的内镜下减压时间、总手术时间和住院日均显著优于经椎板间组(P<0.05)。随时间推移,两组患者VAS评分显著减少(P<0.05),而JOA评分显著增加(P<0.05)。术后不同时间点经椎间孔组VAS和JOA评分均显著优于经椎板间组(P<0.05)。影像方面,两组患者术后CT测量单侧椎管面积均较术前明显增大(P<0.05),术后不同时间点经椎间孔组CT测量的单侧椎管面积显著大于经椎板间组(P<0.05)。[结论]经椎间孔后路内镜治疗腰神经根管狭窄症的早期临床结果显著优于经椎板间入路。

[Objective]To compare the short-term clinical outcomes of endoscopic decompression through transforaminal versus interlaminar approaches for lumbar nerve root canal stenosis.[Methods]From January 2017 to May 2019,a total of 80 patients who were undergoing percutaneous endoscopic decompression for lumbar nerve root canal stenosis were included in this study,and were randomly divided into the two groups.Of them,40 patients had percutaneous endoscopic decompression performed through the transforaminal approach,while the remaining 40 patients had the operation done through the interlaminar approach.The documents involved to the perioperative period,short-term follow and CT scanning were compared between the two groups.[Results]No serious complications happened in any patient of both groups during operation.The transforaminal group proved significantly superior to the interlaminar group regarding to time consumed in endoscopic decompression,total operation time and hospital stay(P<0.05),nevertheless the former spent significantly longer time to setup the working channel than the latter(P<0.05).As time went the VAS score significantly decreased,whereas the JOA score significantly increased in both groups(P<0.05).The transforaminal group was significantly superior to the interlaminar group in aforesaid two scores at all time points postoperatively(P<0.05).In term of radiographic assessment,unilateral spinal canal area measured on CT images significantly enlarged postoperatively compared with those before operation in both groups(P<0.05).In addition,the transforaminal group got significantly larger spinal canal area than the interlaminar group at all time points postoperatively(P<0.05).[Conclusion]The transforaminal endoscopic decompression does achieve superior short-term outcomes to the interlaminar counterpart for lumbar nerve root canal stenosis.