经皮全可视脊柱内镜360°椎管减压术治疗腰椎管狭窄症的临床对照研究

A Clinical Controlled Study on the Treatment of Lumbar Spinal Stenosis with 360°Spinal Canal Decompression with Percutaneous Full-view Spine Endoscopy

目的比较经皮全可视脊柱内镜下360°椎管减压术和后路腰椎管减压内固定植骨融合术(PLIF)治疗腰椎管狭窄症(LSS)的临床疗效。方法回顾性分析2018年10月—2019年3月在菏泽市立医院脊柱外科行经皮全可视脊柱内镜下360°腰椎管减压术和PLIF的67例LSS患者的临床资料,分为两组:内镜组(A组)34例,行经皮全可视脊柱内镜下360°椎管减压术;PLIF组(B组)33例,行PLIF。对比出血量、住院时间、术后腰腿疼的疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、腰总活动度(ROM),评价两组患者的临床疗效。结果A组出血量为(59.3±12.6)mL低于B组(242.0±29.1)mL,差异有统计学意义(t=33.520,P<0.001)。A组住院时间为(4.7±1.2)d低于B组(12.8±2.4)d,差异有统计学意义(t=17.551,P<0.001)。A组术后1年时腰腿疼痛VAS评分为(1.12±0.54)分低于B组(2.74±1.52)分,差异有统计学意义(t=5.847,P<0.001);ODI:A组ODI指数为(13.8±1.15)%低于B组(15.8±2.33)%,差异有统计学意义(t=4.476,P<0.001);A组ROM为(71.2±9.37)°,优于B组(42.4±8.29)°,差异有统计学意义(t=13.310,P<0.001)。结论经皮全可视脊柱内镜下360°椎管减压术治疗腰椎管狭窄症,创伤小、恢复快、减压效果好,保留腰椎活动功能,疗效优于后路腰椎管减压内固定植骨融合术。

Objective To compare the clinical efficacy of percutaneous full-view spinal endoscopy with 360°spinal decompression and posterior lumbar spinal decompression and internal fixation and bone graft fusion(PLIF)in the treatment of lumbar spinal stenosis(LSS).Methods A retrospective analysis of the clinical data of 67 patients with LSS who underwent 360°lumbar spinal decompression and PLIF in the Department of Spine Surgery of Heze Municipal Hospital from October 2018 to March 2019 were divided into two groups:34 cases in the endoscopy group(group A)underwent 360°spinal decompression under percutaneous full-view spine endoscopy;33 cases in the PLIF group(group B)underwent PLIF.The blood loss,length of hospital stay,VAS score,ODI,and total waist range(ROM)of postoperative back and leg pain were compared to evaluate the clinical efficacy of the two groups of patients.Results The blood loss in group A was(59.3±12.6)mL lower than that in group B(242.0±29.1)mL,and the difference was statistically significant(t=33.520,P<0.001).The length of hospital stay in group A was(4.7±1.2)d lower than that in group B(12.8±2.4)d,and the difference was statistically significant(t=17.551,P<0.001).The VAS score of lumbar and leg pain in group A at 1 year after surgery was(1.12±0.54)points lower than that in group B(2.74±1.52)points,the difference was statistically significant(t=5.847,P<0.001).ODI:The ODI index of group A was(13.8±1.15)%lower than that of group B(15.8±2.33)%,the difference was statistically significant(t=4.476,P<0.001).The total ROM of lumbar spine in group A was(71.2±9.37)°,which was better than that in group B(42.4±8.29)°,the difference was statistically significant(t=13.310,P=0.001).Conclusion 360°spinal canal decompression under percutaneous full-view spine endoscopic treatment of lumbar spinal stenosis has less trauma,quick recovery,good decompression effect,and retains the function of lumbar spine movement.The curative effect is better than posterior lumbar spinal canal decompression and internal fixation with bone grafting and fusion.