全内镜下椎板开窗术治疗退行性腰椎侧隐窝狭窄症

Treatment of degenerative lumbar lateral recess stenosis with full endoscopic lamina fenestration discectomy

目的:比较全内镜下椎板开窗术(full endoscopic lamina fenestration discectomy,Endo-LOVE)与全内镜下椎间孔入路椎管减压术治疗退行性腰椎侧隐窝狭窄症的疗效。方法:对2018年3月至2019年3月收治的48例退行性腰椎侧隐窝狭窄症患者进行回顾性分析,其中男32例,女16例,年龄60~83(72.9±6.5)岁,病程5~16(8.0±2.8)年,按不同手术方式分为观察组(采用Endo-LOVE术式,28例)和对照组(采用全内镜下椎间孔入路椎管减压术式,20例)。观察两组患者的手术时间、术中出血量、住院时间、并发症,比较两组患者手术前后视觉模拟评分(visual analgue scale,VAS),日本矫形外科协会(Japanese Orthopaedic Association,JOA)评分,Oswestry功能障碍指数(Oswestry disability index,ODI),侧隐窝角,并采用改良Macnab标准评价临床疗效。结果:两组患者随访时间、手术时间差异无统计学意义(P>0.05)。术中出血量观察组5~15(8.4±3.6)ml,对照组5~25(11.5±5.4)ml;住院时间观察组5~8(6.0±1.0)d,对照组6~9(7.2±1.1)d;术中出血量和住院时间观察组少于对照组(P<0.05)。两组均无手术严重并发症发生。两组患者术后3个月和末次随访时的VAS、JOA评分、ODI均明显优于术前(P<0.05),且观察组明显优于对照组(P<0.05)。两组患者术后3 d测量的骨性、软性侧隐窝角均明显大于术前(P<0.05),观察组明显优于对照组(P<0.05)。在末次随访时采用改良Macnab标准评价临床疗效,观察组优22例,良5例,一般1例;对照组优11例,良4例,一般5例;观察组疗效优于对照组(P<0.05)。结论:两种术式操作均在直视下进行,安全性高,均取得了较好的临床疗效,但Endo-LOVE术式扩大侧隐窝更为充分。

Objective To compare the clinical efficacy of full endoscopic lamina fenestration discectomy(Endo-LOVE)with full endoscopic transforaminal approach discectomy in the treatment of degenerative lumbar lateral recess stenosis.Methods A retrospective analysis of 48 patients with degenerative lumbar lateral recess stenosis between March 2018 and March 2019 was performed.There were 32 males and 16 females,aged from 60 to 83 years old with an average of(72.9±6.5)years,course of disease ranged from 5 to 16 years with an average of(8.0±2.8)years.The patients were divided into observation group and control group according to surgical approaches.There were 28 cases in observation group,underwent Endo-LOVE surgery;and 20 cases in control group,underwent full endoscopic foraminal approach discectomy.The operation time,intraoperative blood loss,hospitalization day and complications were observed between two groups.Visual analgue scale(VAS),Japanese Orthopaedic Association(JOA),Oswestry Disability Index(ODI),lateral crypt angle were compared between two groups.And clinical effects were evaluated by modified Macnab standard.Results There was no significant difference in follow-up and operation time between two groups(P>0.05).Intraoperative blood loss was from 5 to 15 ml with an average of(8.4±3.6)ml in observation group and 5 to 25 ml with an average of(11.5±5.4)ml in control group.The hospitalization day was from 5 to 8 days with an average of(6.0±1.0)days in observation group and 6 to 9 days with an average(7.2±1.1)days in control group.Intraoperative blood loss and hospitalization day were significantly lower in observation group(P<0.05).There were no serious complications in both groups.The VAS,JOA scores,and ODI at 3-month and final follow-up were significantly improved in both groups(P<0.05),and observation group was significantly better than control group(P<0.05).The skeletal lateral crypt angle and soft lateral crypt angle were significantly greater than the preoperative angle at 3 days postoperatively(P<0.05),and observation group was significantly better than control group(P<0.05).At the final follow-up,the modified Macnab criteria was used to assess clinical efficacy,in observation group,22 patients obtained excellent results,5 good and 1 fair;while 11 excellent,4 good and 5 fair in control group;the clinical efficacy of observation group was significantly better than that of control group(P<0.05).Conclusion Both surgical methods are performed under direct vision,with high safety and good clinical efficacy.However,Endo-LOVE enlarged the lateral crypt more fully.