经皮椎间孔镜技术与传统后入路减压植骨融合内固定术治疗老年退行性腰椎管狭窄症的近期疗效比较

Comparison of short-term efficacy between percutaneous intervertebral foramen technique and traditional posterior approach decompression and bone grafting and internal fixation in the treatment of senile degenerative lumbar spinal stenosis

目的 比较经皮椎间孔镜技术与传统后入路减压植骨融合内固定术治疗老年退行性腰椎管狭窄症的近期疗效。方法 我院2018年1月~2021年1月收治的老年退行性腰椎管狭窄症病人100例,根据不同手术方法将其分为观察组和对照组,每组各50例。观察组采用经皮椎间孔镜技术,对照组采用传统后入路减压植骨融合内固定术,比较两组临床疗效,围术期相关指标、腰椎功能、疼痛程度、骨代谢指标及并发症。结果 观察组手术时间、术后卧床时间、住院时间均短于对照组,术中失血量少于对照组,差异有统计学意义(P<0.05);观察组并发症发生率低于对照组,临床总有效率高于对照组,差异有统计学意义(P<0.05);术后1周及术后3个月,观察组骨特异性碱性磷酸酶(BALP)、骨钙素(BGP)、骨形态发生蛋白-2(BMP-2)水平高于对照组,差异有统计学意义(P<0.05);术后1周及术后3个月,观察组Oswestry功能障碍指数(ODI)、日本骨科学会腰痛疾患评定表(JOA)评分高于对照组,视觉疼痛模拟(visual analogue scale, VAS)评分低于对照组,差异有统计学意义(P<0.05)。结论 经皮椎间孔镜治疗退变性腰椎管狭窄症对病人创伤更小,利于恢复,安全性更高,治疗疗效良好。

Objective To compare the short-term efficacy of percutaneous foraminal endoscopy and traditional posterior decompression,bone grafting,fusion and internal fixation in the treatment of senile degenerative lumbar spinal stenosis.Methods 100 elderly patients with degenerative lumbar spinal stenosis admitted to Hainan Qionghai People’s Hospital from January 2018 to January 2021 were selected as the study subjects.They were divided into the observation group(50 case)and the control group(50 case)according to different surgical methods.The observation group used percutaneous foraminal endoscopy technology,and the control group used traditional posterior approach decompression and bone graft fusion internal fixation.Compare the clinical efficacy,perioperative related indicators,lumbar function,pain level,bone metabolism indicators,and complications between two groups.Results The observation group had shorter surgery,postoperative bed rest,and hospital stay compared to the control group,with less intraoperative blood loss compared to the control group(P<0.05).The incidence of complications in the observation group was lower than that in the control group,and the total clinical effective rate was higher than that in the control group(P<0.05);One week and three months after surgery,the levels of bone specific alkaline phosphatase(BALP),osteocalcin(BGP),and bone morphogenetic protein-2(BMP-2)in the observation group were higher than those in the control group(P<0.05);At 1 week and 3 months after surgery,the Oswestry Dysfunction Index(ODI)and Japanese Orthopedic Society Low Back Pain Assessment Scale(JOA)scores in the observation group were higher than those in the control group,while the visual analog scale(VAS)score was lower than that in the control group(P<0.05).Conclusion The treatment of degenerative lumbar spinal stenosis with percutaneous transforaminal endoscopy is less traumatic,beneficial for recovery,safer,and has a good therapeutic effect.