微创镜下减压治疗退行性腰椎椎管狭窄症的临床研究

Clinical study of minimally invasive decompression in the treatment of degenerative lumbarspinal stenosis

目的分析比较侧入路经皮椎间孔镜手术(PELD)和显微内窥镜手术(MED)治疗退行性腰椎椎管狭窄症(LSS)的临床效果。方法回顾分析2018年1月至2019年12月在湖北省宜昌市中心人民医院脊柱外科住院接受PELD(36例)和MED(36例)治疗的LSS患者的病历资料。其中PELD组男性与女性患者各18例,年龄(61.56±9.87)岁;MED组男性20例,女性16例,年龄(62.61±9.19)岁。统计两组患者相关临床指标、腿痛VAS评分、ODI评分及术后第三个月改良MacNab标准及并发症情况。结果所有患者均获得随访,随访率100%,PELD组随访时间3~7个月,平均(3.98±2.43)个月;MED组随访时间4~9个月,平均(4.52±2.92)个月。PELD组手术切口长度、术中出血量、术后切口渗出时间、术后卧床和住院时间([0.81±0.16)cm、(13.75±5..52)ml、(2.12±1.35)d、(15.29±4.64)h、(5.25±1.72)d],均少于MED组([1.89±0.25)cm、(32.05±8.34)ml、(4.37±2.56)h、(59.35±11.32)h、(6.47±2.03)d],差异均有统计学意义(均P<0.05);但MED组手术时间[(83.65±17.69)min]和术中透视次数[(3.72±1.45)次]少于PELD组[(95.14±23.21)min、(13.25±4.32)次],差异有统计学意义(P<0.05)。两组患者在住院费用[PELD组:(2.54±0.29)万;MED组:(2.51±0.42)万]上,差异无统计学意义。两组患者组间术后第一天、术后1个月、术后3个月组间VAS比较(F=6.466、5.261、4.326,P=0.013、0.025、0.041)及术后1个月、术后3个月ODI(%)评分(F=6.073、5.071,P=0.016、0.027)比较,差异均有统计学意义(P<0.05),两组患者组内各时间点腿痛VAS及ODI(%)评分差异均有统计学意义(P<0.001),随着时间的延长,腿痛VAS及ODI(%)评分逐渐降低。MacNab标准评判的手术疗效显示两种手术方式均有较高的有效率(>90%)和优良率(>85%),组间差异无统计学意义(P>0.05)。结论PELD和MED各有优势,在把握其适用范围的前提下均为治疗LSS的有效方法。

Objective To analyze and compare the clinical effects of two endoscopic surgical methods(PELD and MED)in the treatment of degenerative lumbar spinal stenosis(LSS),and to study the therapeutic advantages of the two surgical methods.Methods The medical records of LSS patients receiving PELD(36 cases)and MED(36 cases)in the spinal surgery department of Yichang Central People's Hospital,Hubei Province from January 2018 to December 2019 were retrospectively analyzed.In the PELD group,there were 18 male and 18 female patients,aged(61.56±9.87)years.There were 20 males and 16 females(62.61±9.19 years old)in the MED group.Relevant clinical indicators,VAS score of leg pain,ODI score,improved MacNab standard and complications in the third month after surgery were calculated.Results All patients were followed up with a follow-up rate of 100%.The follow-up time of the PELD group was 3-7 months,with an average of(3.98±2.43)months.The follow-up time of the MED group was 4-9 months,with an average of(4.52±2.92)months.The length of incision,intraoperative blood loss,postoperative incision exudation time, postoperative bed rest and hospitalization time in the PAD group [(0.81 ± 0.16) cm, (13.75 ±5.52) ml, (2.12±1.35) d, (15.29±4.64) h, (5.25±1.72) d] were all lower than those in the Med group [(1.89±0.25) cm, (32.05±8.34) ml, (4.37±2.56) h, (59.35±11.32) h, (6.47±2.03) d]. The differences were statisticallysignificant (all P<0.05). However, the operative time [(83.65±17.69) min] and the number of intraoperativefluoroscopy [(3.72±1.45) times] in the MED group were less than those in the PELD group [(95.14±23.21)min and (13.25±4.32) times], and the difference was statistically significant (P<0.05). There was no significantdifference in hospitalization expenses between the two groups [PELD group: (2.54±0.29) ten thousand;MED group: (2.51±0.42) ten thousand. Between the two group patients on the first day after operation, postoperative1 month, 3 months after operation VAS comparison between groups (F=6.466, 5.261, 4.326, P=0.013, 0.025, 0.041) and postoperative 1 month, 3 months after operation of ODI (%) score (F=6.073, 5.071,P=0.016, 0.027), the difference had statistical significance (P<0.05), two groups of patients with leg painVAS and ODI at each time point in the group (%) score difference had statistical significance (P<0.001), withthe extension of time, The VAS and ODI (%) scores of leg pain decreased gradually. MacNab standard evaluationof surgical efficacy showed that the two surgical methods had high effective rate (>90%) and excellentand good rate (>85%), there was no significant difference between groups, there was no statistical significance(P>0.05). Conclusions PELD and MED have their own advantages, and both of them are effectivemethods to treat LSS under the premise of grasping its applicable scope.