脊柱内镜下减压融合内固定术治疗腰椎管狭窄症的疗效

Efficacy of endoscopic decompression,fusion and internal fixation in the treatment of lumbar spinal stenosis

目的探讨脊柱内镜下减压融合内固定术治疗腰椎管狭窄症的疗效。方法选取2019年9月~2021年9月我院腰椎管狭窄症患者50例,将其随机分为观察组和对照组,25例1组,观察组给予全脊柱内镜下减压融合内固定术,对照组给予传统开放性手术治疗。比较两组手术时间、术中出血量、住院时间,术后24、48、72 h手术切口疼痛视觉模拟量表(VAS)评分,术后3月、12月随访Oswestry功能障碍指数(ODI),术后12月随访融合率并观察术后并发症。结果观察组手术时间、术中出血量、住院时间优于对照组(P<0.05),差异有统计学意义。两组患者术后24、48、72 h VAS评分差异有统计学意义(P<0.05)。两组患者术后3月、12月随访ODI评分较术前明显改善(P<0.05)。两组患者术后3月或12月融合节段Cobb角变化、术后12月融合率的差异无统计学意义(P>0.05)。实验组并发症发生率为8%(2/25),对照组并发症发生率为12%(3/25),差异有统计学意义(P<0.05)。结论脊柱内镜下椎管减压、腰椎间融合、经皮椎弓根钉术治疗腰椎管狭窄症的治疗效果明显优于传统手术。

Objective To investigate the efficacy of spinal endoscopic decompression fusion internal fixation in the treatment of lumbar spinal stenosis.Methods Fifty patients with lumbar spinal stenosis in our hospital from September 2019 to September 2021 were selected and randomly divided into the observation group(given total spinal endoscopic decompression fusion internal fixation)and the control group(given traditional open surgery),twenty-five cases/group.The operation time,intraoperative blood loss and hospital stay were compared.The visual analogue scale(VAS)score of incision pain was compared at 24,48 and 72 hours after operation.The Oswestry disability index(ODI)and Cobb angle were followed up at 3 and 12 months after operation,and the fusion rate was observed at 12 months after operation.Postoperative complications were followed up 12 months after operation.Results The observation group was significantly better than the control group in terms of operative time,intraoperative bleeding and hospital stay(P<0.05).There was a statistically significant difference in VAS scores at 24,48 and 72 hours after surgery between the two groups(P<0.05).The ODI scores at 3 and 12 months postoperative follow-up were significantly improved compared with those before surgery in both groups(P<0.05).There was no statistically significant difference between the two groups in the change of Cobb angle of the fused segment at 3 or 12 months after surgery and the fusion rate at 12 months after surgery(P>0.05).The complication rate was 8%(2/25)in the experimental group and 12%(3/25)in the control group,and the difference was statistically significant(P<0.05).Conclusion The therapeutic effect of spinal endoscopic spinal decompression,lumbar interbody fusion,and percutaneous pedicle nailing for lumbar spinal stenosis are significantly better than that of traditional surgery.