微创通道手术显微镜下单侧入路双侧减压术与传统手术治疗腰椎管狭窄症疗效对比

发布时间：2018-11-20 12:54

【摘要】：目的:探讨微创通道手术显微镜下单侧入路双侧减压术与传统腰椎后路双侧椎板开窗减压术治疗腰椎管狭窄症的疗效对比及优缺点。方法:回顾性分析2015年8月-2017年3月因单节段腰椎管狭窄症患者采用微创通道手术显微镜下椎板开窗减压术20例(微创组)和传统腰椎后路双侧椎板开窗减压术21例(传统组)的手术时间、术中透视时间、出血量、术后并发症、术前术后腰腿部视觉疼痛模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)评分及影像学资料评价2组手术治疗效果。结果:1例传统手术及2例微创手术术中出现硬膜撕裂,术中给予脑棉片、明胶海绵压迫止脑脊液漏,术后予以切口严密缝合加压包扎及抗生素预防感染,切口愈合良好,未出现明显的并发症。所有患者术后均给予至少六个月的随访,两组患者术前常规资料及腰腿部VAS评分、腰椎ODI评分差异无统计学意义(P0.05)。微创组手术时间及术中透视时间多于传统组,而传统组术中出血量及术后引流量明显多于微创组术中出血量(微创组术后未放置引流管,P0.05),微创组术后平均住院日少于开放组(P0.05)。与术前相比,两组术后腰痛、腿痛VAS评分、ODI评分均降低(P0.05),两组术后腿痛VAS评分及ODI评分比较无统计学意义(P0.05),但是微创组术后腰痛VAS评分低于开放组(P0.05)。临床疗效,微创组优11例,良6例,可3例,差0例,微创组优良率85.0%;传统组优13例,良5例,可3例,差0例,优良率85.7%,两组之间优良率差异无统计学意义(P0.05)。结论:与传统手术相比,微创通道手术显微镜下治疗单节段腰椎管狭窄可以获得良好的临床效果,并且具有手术创伤小、出血量少、术后无需引流、并发症少、康复时间短等优点,值得进一步的临床实践推广。
[Abstract]:Objective: to compare the curative effect and advantages and disadvantages of bilateral decompression with unilateral approach and traditional posterior laminectomy in the treatment of lumbar spinal stenosis. Methods: from August 2015 to March 2017, 20 cases (minimally invasive group) with laminectomy and decompression of bilateral laminae with traditional posterior approach for unilateral lumbar spinal stenosis were analyzed retrospectively. Operative time of 21 cases (traditional group), Intraoperative fluoroscopy time, bleeding volume, postoperative complications, preoperative and postoperative visual pain analogue score of waist and leg (visual analogue scale,VAS), Oswestry dysfunction index (Oswestry disability index,ODI) score and imaging data were used to evaluate the effect of operation in both groups. Results: 1 case of traditional operation and 2 cases of minimally invasive operation appeared dura tear. During the operation, they were treated with brain cotton slice, gelatin sponge compression and cerebrospinal fluid leakage. After operation, the incision was closely sutured and pressurized and bandaged with antibiotics to prevent infection. The wound healed well. There were no obvious complications. All patients were followed up for at least six months. There was no significant difference in preoperative routine data, lumbar VAS score and lumbar ODI score between the two groups (P0.05). The operative time and fluoroscopy time in the minimally invasive group were longer than those in the traditional group, while the intraoperative bleeding volume and postoperative drainage volume in the traditional group were significantly higher than those in the minimally invasive group (no drainage tube was placed in the minimally invasive group, P0.05). The average hospital stay in the minimally invasive group was less than that in the open group (P0.05). Compared with preoperative, the VAS score and ODI score of postoperative low back pain, leg pain in both groups were decreased (P0.05). The VAS score and ODI score of leg pain in the two groups were not statistically significant (P0.05). But the VAS score of postoperative low back pain in the minimally invasive group was lower than that in the open group (P0.05). The clinical effect was excellent in the minimally invasive group (n = 11), good in 6 cases, fair in 3 cases and poor in 0 cases. The excellent and good rate of the minimally invasive group was 85.0%. In the traditional group, 13 cases were excellent, 5 cases were good, 3 cases were fair, 0 cases were poor, and the excellent and good rate was 85.7%. There was no significant difference between the two groups (P0.05). Conclusion: compared with the traditional operation, the treatment of single-segment lumbar spinal stenosis under the microscope of minimally invasive channel surgery can obtain good clinical results, and has the advantages of less surgical trauma, less bleeding, less postoperative drainage and fewer complications. The advantages of short rehabilitation time are worthy of further promotion in clinical practice.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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