椎间孔镜技术下经椎板间入路治疗腰椎间盘突出症合并侧隐窝狭窄的近期效果观察

Observation on the effect of the treatment of lumbar disc herniation with lateral recess stenosis through the interlaminar approach under the technique of intervertebral foramen

目的探讨椎间孔镜技术下经椎板间入路治疗腰椎间盘突出症合并侧隐窝狭窄的近期临床疗效。方法2018年7月~2022年12月我院治疗的腰椎间盘突出症合并侧隐窝狭窄病人132例。根据手术方式分为内镜组和传统组,内镜组70例,采用椎间孔镜技术下经椎板间入路治疗,传统组62例,采用传统开放手术治疗,对比两种方法的手术指标、术后病人临床症状缓解情况。结果内镜组的平均手术时间(76.1±7.5)分钟、手术出血量(30.5±8.4)ml、切口长度(0.88±0.12)cm、手术后引流量(24.5±4.4)ml、卧床时间(26.8±4.4)小时、住院时间(5.6±1.8)天,传统组分别为(88.0±9.3)分钟、(103.4±18.6)ml、(6.10±1.04)cm、(208.3±34.0)ml、(32.7±6.6)小时、(9.4±2.0)天,两组比较差异有统计学意义(P<0.05)。两组病人术后3个月、6个月VAS评分较术前均降低,JOA评分增高,差异有统计学意义(P<0.05);内镜组腰椎功能优43例(61.43%)、良15例(21.43%),传统组分别为29例(46.77%)、17例(21.43%),两组比较差异无统计学意义(P>0.05);两组病人手术并发症发生率分别为2.86%、11.29%,两组比较差异无统计学意义(P>0.05)。结论椎间孔镜技术下经椎板间入路治疗腰椎间盘突出症合并侧隐窝狭窄和传统开放手术均可达到较好恢复效果,有效缓解临床症状,其优势在于手术时间更短,创伤更小。

Objective This study explored the clinical effect of using transforaminal technique to treat patients with lumbar disc herniation and lateral recess stenosis.Methods 132 patients with lumbar disc herniation and lateral recess stenosis who were treated by orthopedic surgery in our hospital from July 2018 to December 2022 were selected for retrospective analysis.They were divided into the endoscopic group and the traditional group according to the surgical method.70 patients in the endoscopic group were treated by the inter-laminar approach under the technique of intervertebral foramen,and 62 patients in the traditional group were treated by the traditional open surgery.The operation process indexes of the two methods were compared The clinical symptoms of patients after operation were different.Results The average operation time[(76.1±7.5)min],surgical blood loss[(30.5±8.4)ml],incision length[(0.88±0.12)cm],post-operative drainage[(24.5±4.4)ml],bed time[(26.8±4.4)h],and length of stay[(5.6±1.8)d]in the endoscopic group were significantly lower than those in the traditional group[(88.0±9.3)min,(103.4±18.6)ml,(6.10±1.04)cm,(208.3±34.0)ml,(32.7±6.6)h and(9.4±2.0)d,respectively].The difference was statistically significant(P<0.05).VAS scores of 3 months and 6 months after surgery were lower than those before surgery,and JOA scores were higher,the difference was statistically significant(P<0.05).The lumbar function of the endoscopic group was excellent in 43 cases(61.43%)and good in 15 cases(21.43%),29 cases of lumbar spine function were excellent(46.77%)and 17 cases(21.43%)were good in the traditional group.Overall,there was no statistically significant difference in the recovery of lumbar spine function between the endoscopic group and the traditional group(P>0.05).2 patients(2.86%)in the endoscopy group had postoperative complications,and 7 patients(11.29%)in the traditional group had postoperative complications,but there was no significant statistical difference in the incidence of surgical complications between the two groups(P>0.05).Conclusion For the treatment of lumbar disc herniation with lateral recess stenosis under intervertebral foraminal technique,the treatment of lumbar intervertebral disc herniation with lateral recess stenosis can achieve better functional recovery and effectively relieve the clinical symptoms of the patient,but its advantage lies in the operation time.Shorter,less traumatic impact on patients.