摘要
目的比较钬激光联合全脊柱内镜和单纯脊柱内镜减压术治疗颈腰椎术后相邻节段退行性病变的临床效果。方法选取2019年1月至2019年12月,颈腰椎融合术后相邻节段退行性病变患者65例。根据治疗方法不同,分为观察组和对照组。观察组患者31例,采用全脊柱内镜技术下钬激光治疗,平均激光治疗功率12 W;对照组患者34例,采用单纯全脊柱内镜技术治疗。记录两组手术时间、住院时间、并发症、复发情况。术后1 d、7 d、1个月、3个月、6个月采用视觉模拟量表(Visual analogue scale,VAS)和Oswestry功能障碍指数(Oswestry disability index,ODI)评分进行疗效判定。结果两组患者手术时间差异无统计学意义(P>0.05)。观察组术中失血量(8.64±4.4) ml明显少于对照组(15.7±8.7) ml,差异具有统计学意义(P<0.05)。观察组住院天数(3.15±2.5)d少于对照组(5.67±2.6) d,差异具有统计学意义(P<0.05);两组患者术前VAS和ODI评分差异无统计学意义(P>0.05),术后1 d、7 d、1个月、3个月、6个月观察组VAS和ODI评分显著优于对照组,差异具有统计学意义(P<0.05)。两组患者均未出现严重并发症。对照组3例患者发生术后一过性感觉迟钝,均在保守治疗1个月内恢复;观察组1例出现术中的同侧下肢烧灼感,钬激光消融停止时,烧灼感消失。治疗后6个月对照组4例复发,观察组无复发。结论全脊柱内镜下联合钬激光治疗颈腰椎融合术后相邻节段退行性病变较单纯脊柱内镜治疗疗效好、并发症少、复发率低。
Objective To compare the clinical effects of holmium laser combined with whole spine endoscopy and simple spine endoscopy in the treatment of adjacent degenerative diseases after cervical and lumbar surgery.Methods Totally 65 Patients with adjacent degenerative diseases after cervical and lumbar fusion who underwent total spinal endoscopic therapy during the period from Jan.2019 to Dec.2019 were selected as the study subjects.The patients were divided into the observation group and control group according to the presence or absence of additional holmium laser treatment.The patients in the observation group were given additional holmium laser therapy supported with whole spine endoscopic technique.The patients in the control group were treated with whole spine endoscopic technique alone.All the patients underwent the following inclusion and exclusion criteria.Totally,31 patients in the observation group and 34 patients in the control group were finally included in this study.Their baseline data such as age,gender and duration of symptoms and their operation time,hospital stay,complications and recurrence rate were recorded.Their visual analogue scale(VAS) and Oswestry disability index(ODI) scores were recorded respectively 1 day,7 days and 1,3 and 6 months after the surgery.Results There was no significant difference in the baseline data or in the operation time between the two groups(P>0.05).The intraoperative blood loss(8.64±4.4) ml in the observation group was less than that(15.7±8.7) ml in the control group,and the difference was statistically significant(P<0.05).The hospital stay(3.15±2.5) days in the observation group was shorter than that(5.67±2.6) days in the control group,and the difference was statistically significant(P<0.05).The difference between the two groups in the preoperative VAS and ODI scores were not statistically significant(P>0.05).The VAS and ODI scores of the observation group 1 day,7 days,and 1,3 and 6 months after the operation were all better than those of the control group,and the differences were statistically significant(P<0.05).No serious complication was observed in either group,including spinal instability,cerebrospinal fluid leakage,vascular injury and surgical infection.Postoperative transient dysesthesia was observed in 3 patients in the control group,which disappeared after 1 month’s conservative treatment.The only observed laser-related complication was a burning sensation in the ipsilateral lower extremity during the surgery in 1 case,which disappeared when holmium laser ablation stopped.There were 4 cases of recurrence within 6 months in the control group and no recurrence in the observation group.Conclusions Spinal endoscopy combined with holmium laser has better therapeutic effect and less complication rate than sole application of spinal endoscopy.In addition,our results suggest that combined holmium laser treatment is superior in preventing postoperative recurrence.
作者
裴博
刘华
罗吉伟
PEI Bo;LIU Hua;LUO Ji-wei(Department of Spine Surgery,Foshan Jianxiang Hospital,Foshan 528000,China;Department of Osteoporosis,Chancheng District People’s Hospital of Foshan city;Department of Osteoarthrosis,Zengcheng Branch,Nanfang Hospital,Southern Medical University)
出处
《中国激光医学杂志》
CAS
2021年第5期241-246,共6页
Chinese Journal of Laser Medicine & Surgery
基金
佛山市科技创新项目(1920001000448)
佛山市自筹经费类科技计划项目(2018AB001791)。
关键词
全脊柱内镜技术
钬激光
颈腰椎融合术后
相邻节段退行性病变
Whole spine endoscopic technique
Holmium laser
Post-operation of cervical and lumbar fusion
Adjacent degenerative diseases