Endo-LOVE技术中应用可视环锯治疗退行性腰椎管狭窄症的疗效分析

Analysis of clinical efficacy of Endo-LOVE by using visual trephine in treatment for degenerative lumbar spinal stenosis

目的 探讨在全内镜下椎板开窗术(Endo-LOVE)中采用可视环锯行椎管扩大成形治疗退行性腰椎管狭窄症的临床疗效。方法 选取2019年9月—2020年9月我院采用Endo-LOVE手术方式治疗的69例退行性腰椎管狭窄症患者,术中均应用可视环锯进行椎管扩大成形。统计平均手术时间、术中透视次数、术中出血量、住院日及术后并发症的发生率。分别在术前、术后1 d、术后3个月和末次随访时间点,使用疼痛视觉模拟评分(VAS)、功能障碍Oswestry指数(ODI)对患者进行评估,并使用改良MacNab评价患者的临床疗效。总结Endo-LOVE术式中应用可视环锯的技术优势。结果 69例患者手术均顺利完成,手术时间(66.9±12.4) min,术中出血量(10.7±6.1) mL,术中透视次数(3.1±1.2)次,平均住院日(6.4±1.0) d,术后出现脑脊液漏1例,未出现神经损伤、感染等其他并发症。随访时间3~8个月,术后1 d、3个月、末次随访时的ODI指数及腰痛和腿痛VAS评分均较术前明显改善,差异有统计学意义(P<0.05)。末次随访时,采用改良MacNab标准评价临床疗效:优62例,良4例,可3例,优良率为95.65%。结论 可视环锯在Endo-LOVE技术治疗退行性腰椎管狭窄症中的应用有助于缩短手术时间,减压范围广,可视化操作,安全性高,临床疗效满意,可在脊柱内镜手术中推广。

Objective To evaluate the clinical efficacy of full endoscopic lamina fenestration discectomy(Endo-LOVE)by using visual trephine in the treatment of degenerative lumbar spinal stenosis.Methods From September 2019 to September 2020,69 cases with degenerative lumbar spinal stenosis accepted Endo-LOVE by using visual trephine.The operation time,blood loss during operation,times of intraoperative radiation and the complications were recorded.The leg and low back pain Visual analogue score(VAS),Oswestry disability index(ODI)and modified MacNab were assessed preoperation,1d,3 months postoperation and at the follow-ups.The technical advantages of visual trephine in Endo-LOVE were summarized.Results All of the 69 operations were completed successfully with operational time 45~90(66.9±12.4)min,blood loss during operation 5~30(10.7±6.1)mL,2~7(3.1±1.2)times of intraoperative radiation,5~8(6.4±1.0)days of hospitalization time.1patient occurred cerebrospinal fluid leakage in postoperation.There were not other complications,such as nerve root injury or infection.All the patients were followed up for 3~8(6.1±1.5)months.The ODI,the low back pain and leg VAS in the 1day,3months,last follow-up of postoperation were all improved compared with preoperation.The differences were statistic significantly(P<0.05).The clinical efficacy was evaluated at the last follow-up by modified MacNab therapeutic effect evaluation criterion,excellent in 62 cases,good in 4cases,fair in 3 cases.The excellent and good rate was 95.65%.Conclusion The application of visual trephine in Endo-LOVE technology helps to shorten the operation time,wide decompression range,visual operation,high safety and satisfactory clinical efficacy,which is worthy of promotion.