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王善坤,杨利斌,柳申鹏,王亚琦.经椎间孔入路经皮内窥镜下椎间盘切除术中采用可视化椎间孔成形技术治疗单节段腰椎椎管狭窄症[J].脊柱外科杂志,2022,20(5):317-321.
经椎间孔入路经皮内窥镜下椎间盘切除术中采用可视化椎间孔成形技术治疗单节段腰椎椎管狭窄症     点此下载全文 (Fulltext)
王善坤  杨利斌  柳申鹏  王亚琦
新乡医学院第一附属医院骨科, 新乡 453100
基金项目:
DOI:10.3969/j.issn.1672-2957.2022.05.006
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摘要:
      目的 探讨经椎间孔入路经皮内窥镜下椎间盘切除术(PETD)中采用可视化椎间孔成形技术治疗单节段腰椎椎管狭窄症(LSS)的疗效和安全性。方法 回顾分析2018年3月—2019年3月采用PETD治疗的58例单节段LSS患者临床资料,其中36例采用“V”区解剖引导的可视化椎间孔成形技术(观察组),22例采用传统椎间孔成形技术(对照组)。记录2组手术时间、术中透视次数、术中出血量、住院时间及并发症(神经根损伤、硬膜囊损伤、血管损伤等)发生情况。术前及术后1、12个月时采用疼痛视觉模拟量表(VAS)评分和Oswestry功能障碍指数(ODI)评估腰腿痛程度及腰椎功能。采用改良MacNab标准评估疗效。结果 所有手术顺利完成,患者随访(13.54±0.56)个月。观察组手术时间、术中透视次数显著低于对照组,差异有统计学意义(P < 0.05);2组术中出血量和住院时间差异无统计学意义(P > 0.05)。2组患者术后各时间点VAS评分、ODI均较术前显著改善,差异有统计学意义(P < 0.05),且VAS评分、ODI均随术后随访时间增加进一步改善;观察组术后1个月VAS评分、ODI显著低于对照组,差异有统计学意义(P < 0.05),2组术后12个月VAS评分、ODI相比,差异无统计学意义(P > 0.05)。2组疗效优良率差异无统计学意义(P > 0.05)。2组术后均未发生严重并发症。结论 PETD中采用可视化椎间孔成形技术治疗单节段LSS与传统椎间孔成形技术疗效相当,并可减少穿刺次数和成形扩张操作次数,减轻患者机体创伤,缩短恢复时间,并可降低医患辐射量,值得临床推广。
关键词:腰椎  椎管狭窄  内窥镜检查  外科手术  微创
Efficacy and safety of visualization foraminoplasty in percutaneous endoscopic transforaminal discectomy for single-segment lumbar spinal stenosis    Fulltext
Wang Shankun  Yang Libin  Liu Shenpeng  Wang Yaqi
Department of Orthopaedics, First Affiliated Hospital, Xinxiang Medical College, Xinxiang 453100, Henan, China
Fund Project:
Abstract:
      Objective To investigate the efficacy and safety of visualization foraminoplasty in percutaneous endoscopic transforaminal discectomy(PETD) for single-segment lumbar spinal stenosis(LSS).Methods The clinical data of 58 patients with single segment LSS treated with PETD from March 2018 to March 2019 were retrospectively analyzed,of which 36 cases were treated with V-zone anatomic guided visual technology for foraminoplasty(observation group) and 22 cases were treated with traditional foraminoplasty technology(control group).The operation time,intraoperative fluoroscopy frequency,intraoperative blood loss,hospital stay and complications(nerve root injury,dural sac injury,blood vessel injury,etc) were recorded in 2 groups.The visual analogue scale(VAS) score and Oswestry disability index(ODI) were used to evaluate the intensity of low back and leg pain and lumbar function before operation and 1 and 12 months after operation.Modified MacNab criteria were used to evaluate the efficacy.Results All the operations were successfully completed,and the patients were followed up for (13.54±0.56) months.The operation time and fluoroscopy frequency in the observation group were significantly shorter and lower than those in the control group,and the differences were statistically significant(P < 0.05).There was no significant difference in intraoperative blood loss and hospital stay between the 2 groups(P > 0.05).VAS scores and ODI at all postoperative time points in 2 groups were significantly lower than those before operation,and the differences were statistically significant(P < 0.05),and VAS score and ODI gradually decreased with time.VAS score and ODI in the observation group were significantly lower than those in the control group at postoperative 1 month,and the differences were statistically significant(P < 0.05).There was no significant difference in VAS score or ODI at postoperative 12 months between the 2 groups(P > 0.05).There was no significant difference in the excellent and good rate between the 2 groups(P > 0.05).No serious complications occurred in both groups.Conclusions In PETD,visualization foraminoplasty for treatment of single-segment LSS has the same efficacy as traditional foraminoplasty,and can reduce the frequency of puncture and expansion operations,reduce the body trauma of patients,shorten the recovery time,and reduce the doctor-patient radiation,thus being worthy of clinical promotion.
Keywords:Lumbar vertebrae  Spinal stenosis  Endoscopy  Surgical procedures  minimally invasive
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