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刘郁林,常跃文,刘粤,尹伟忠,林飞,顾伟,顾楷,李志强.改良经椎板间入路经皮内窥镜下减压术治疗退行性腰椎椎管狭窄[J].脊柱外科杂志,2016,14(6):340-344.
改良经椎板间入路经皮内窥镜下减压术治疗退行性腰椎椎管狭窄     点此下载全文 (Fulltext)
刘郁林1  常跃文1  刘粤2  尹伟忠3  林飞4  顾伟1  顾楷1  李志强1
1. 上海中医药大学附属曙光医院骨科, 上海 200021;
2. 上海市浦东新区公利医院骨科, 上海 200135;
3. 上海市浦东新区人民医院骨科, 上海 201200;
4. 上海市浦东新区中医医院骨伤科, 上海 201299
基金项目:上海市浦东新区卫生、计生科技联合攻关项目(PW2013D-11)
DOI:10.3969/j.issn.1672-2957.2016.06.005
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摘要:
      目的 观察改良经椎板间入路经皮内窥镜下减压术(PEID)治疗退行性腰椎椎管狭窄症(DLSS)的临床效果,为此项技术在临床推广使用提供依据。方法 2013年6月-2015年6月,共74例符合纳入标准的DLSS患者纳入研究,其中男40例,女34例;随机将患者分为传统手术组(传统组)和改良PEID组(改良组),每组各37例。记录2组患者住院天数、手术时间、术中出血量、中央椎管矢径和横径的变化,以及术前、术后3 d、术后3个月、术后6个月疼痛视觉模拟量表(VAS)评分和Oswestry功能障碍指数(ODI),以评估手术效果。结果 所有手术顺利完成,所有患者随访>6个月。在住院天数、术中出血量方面,改良组优于传统组,差异有统计学意义(P<0.05)。2组患者术后3、6个月时VAS评分和ODI均较术前明显改善,差异有统计学意义(P<0.05);但2组间各时间点VAS评分和ODI改善差异无统计学意义(P>0.05)。结论 改良PEID可以取得与开放减压术同样的临床效果。且改良PEID在住院天数、术中出血量等方面明显优于传统开放减压术,提示它是治疗DLSS的安全有效的手术方法。
关键词:腰椎  椎管狭窄  内窥镜检查  减压术,外科  外科手术,微创性
Modified percutaneous endoscopic interlaminar decompression for treatment of degenerative lumbar spinal stenosis    Fulltext
LIU Yu-lin1  CHANG Yue-wen1  LIU Yue2  YIN Wei-zhong3  LIN Fei4  GU Wei1  GU Kai1  LI Zhi-qiang1
1. Department of Orthopaedics, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200021, China;
2. Department of Orthopaedics, Shanghai Pudong New Area Gongli Hospital, Shanghai 200135, China;
3. Department of Orthopaedics, Shanghai Pudong New Area People's Hospital, Shanghai 201200, China;
4. Department of Orthopaedics and Traumatology, Traditional Chinese Medical Hospital of Shanghai Pudong New Area, Shanghai 201299, China
Fund Project:
Abstract:
      Objective To observe the surgical results of modified percutaneous endoscopic interlaminar decompression(PEID) for treatment of degenerative lumbar spinal stenosis(DLSS) to provide basis for popularization of PEID. Methods From June 2013 to June 2015,a total of 74 patients(40 males and 34 females) was brought into the research for degenerative lumbar spinal canal stnosis. Patients were randomly divided into the modified PEID group(modify group) and conventional laminectomy decompression group(convention group),37 in each group. The primary outcome measures included hospital stay,operation time,blood loss,change in sagittal and transverse diameter of the central canal,and also visual analogue scale(VAS) score, Oswestry disability index(ODI) at pre-operation,postoperative 3 d,postoperative 3 months and postoperative 6 months, which were used to evaluate the surgical outcome. Results All the operations were completed successfully,and all the patients were followed up for > 6 months. In the hospital stay,blood loss of the modify group was less than that of the convention group, and the difference was statistically significant. Both groups had significant improvement of VAS score and ODI compared with pre-operation,and the improvement was similar between the 2 groups(P>0.05). Conclusion The modified PEID has the same therapeutic effect with conventional laminectomy decompression,but has its advantages over open decompression in hospital stay and blood loss. So it is a safe and effective surgical option to treat DLSS.
Keywords:Lumbar vertebrae  Spinal stenosis  Endoscopy  Decompression, surgical  Surgical procedures, minimally invasive
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