| 两种入路经皮内镜手术治疗稳定型退变性腰椎滑脱症 |
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投稿时间：2022-02-20
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| 作者 | Author | 单位 | Address | E-Mail |
| 陈启旺 |
CHEN Qi-wang |
宁波市第九医院骨科, 浙江 宁波 315020 |
Department of Orthopaedics, Ningbo No. 9 Hospital, Ningbo 315020, Zhejiang, China |
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| 陈馨卉 |
CHEN Xin-hui |
宁波市第九医院骨科, 浙江 宁波 315020 |
Department of Orthopaedics, Ningbo No. 9 Hospital, Ningbo 315020, Zhejiang, China |
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| 魏珂 |
WEI Ke |
宁波市第九医院骨科, 浙江 宁波 315020 |
Department of Orthopaedics, Ningbo No. 9 Hospital, Ningbo 315020, Zhejiang, China |
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| 吴海昊 |
WU Hai-hao |
中国科学院大学宁波华美医院骨科, 浙江 宁波 315010 |
Department of Orthopaedics, Huamei Hospital, University of Chinese Academy of Sciences, Ningbo 315010, Zhejiang, China |
haihaowu5@163.com |
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| 期刊信息：《中国骨伤》2023年，第36卷，第1期，第48-54页 |
| DOI：10.12200/j.issn.1003-0034.2023.01.009 |
| 基金项目:浙江省医药卫生科技计划项目(编号:2019KY592);宁波市自然科学基金项目(编号:2019A610241) |
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中文摘要:
目的:评价两种入路经皮内镜手术治疗稳定型退变性腰椎滑脱症的疗效。
方法:根据手术入路不同将2016年1月至2019年12月接受经皮内镜手术的64例稳定型退变性腰椎滑脱症患者分为椎间孔入路组(32例)和椎板间入路组(32例)。其中椎间孔入路组男16例,女16例;年龄52~84(66.03±9.60)岁;L2滑脱4例,L3滑脱5例,L4滑脱23例。椎板间入路组男17例,女15例;年龄46~81(61.38±9.88)岁;L3滑脱3例,L4滑脱15例,L5滑脱14例。比较两组患者手术时间、术中X线透视次数、术后卧床时间,测量两组患者术前和术后12个月动力位X线片上滑脱椎体间前后位移变化值、椎体间张开角度变化值、滑脱百分比,观察手术前后腰痛及下肢疼痛视觉模拟评分(visual analgue scale,VAS)和日本骨科协会(Japanese Orthopaedic Association,JOA)评分,并根据改良Macnab标准评定临床疗效。
结果:所有手术顺利完成,两组患者术后均随访1年以上,随访期未见并发症。(1)手术时间组间比较差异无统计学意义(P＞0.05),术中X线透视次数椎间孔入路组大于椎板间入路组(P＜0.05),术后卧床时间椎间孔入路组小于椎板间入路组(P＜0.05)。(2)两组患者术后12个月在动力位X线片上未见腰椎不稳,滑脱椎体间前后位移变化值、椎体间张开角度变化值、滑脱百分比与术前1 d比较差异均无统计学意义(P＞0.05)。(3)两组患者术后3 d,术后1、12个月腰痛VAS和术前比较差异均无统计学意义(P＞0.05),但下肢疼痛VAS与术前比较均明显改善(P＜0.05);两组患者术后12个月JOA评分与术前比较均明显改善(P＜0.05)。术后同时段腰痛及下肢疼痛VAS及JOA评分组间比较差异均无统计学意义(P＞0.05)。术后12个月按照改良Macnab标准评定疗效,椎间孔入路组优21例,良7例,可3例,差1例;椎板间入路组优20例,良7例,可5例,差0例;组间疗效比较差异无统计学意义(P＞0.05)。
结论:椎板间入路手术可减少术中X线透视次数,椎间孔入路手术可缩短术后卧床时间,两种入路经皮内镜手术治疗稳定型退变性腰椎滑脱症均可获得满意疗效,并且短期内滑脱程度无进展。 |
| 【关键词】脊椎滑脱 外科手术,内窥镜 外科入路 |
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| Treatment of stable degenerative lumbar spondylolisthesis with percutaneous endoscopic surgery through two different approaches |
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ABSTRACT
Objective To assess the clinical effects of percutaneous endoscopic surgery through two different approaches for stable degenerative lumbar spondylolisthesis.
Methods Sixty-four patients with stable degenerative lumbar spondylolisthesis who underwent percutaneous endoscopic procedures between January 2016 and December 2019 were divided into transforaminal approach group and interlaminar approach group according to surgical approaches,32 patients in each group. There were 16 males and 16 females in transforaminal approach group,aged from 52 to 84 years old with an average of (66.03±9.60) years,L2 slippage in 4 cases,L3 slippage in 5,and L4 slippage in 23. There were 17 males and 15 females in interlaminar approach group,aged from 46 to 81 years old with an average of (61.38±9.88) years,L3 slippage in 3 cases,L4 slippage in 15,and L5 slippage in 14. Operative time,intraoperative fluoroscopy times,and postoperative bedtime were compared between two groups. Anteroposterior displacement values,interbody opening angles,and the percentage of slippage were measured on preoperative and postoperative 12-month dynamic radiographs. Visual analogue scale (VAS) of low back pain and lower extremity pain,and the Japanese Orthopaedic Association (JOA) score before and after surgery were observed,and clinical effects were evaluated according to the modified MACNAB criteria.
Results All operations were successfully completed,and patients in both groups were followed up for more than 1 year,and without complications during follow-up period. ①There was no significant difference in operation time between two groups(P＞0.05). Intraoperative fluoroscopy times were longer in transforaminal approach group than that in intervertebral approach group(P＜0.05). Postoperative bedtime was shorter in transforaminal approach group than that in intervertebral approach group (P＜0.05).② No lumbar instability was found on dynamic radiography at 12 months postoperatively in both groups. There were no significant differences in anteroposterior displacement values,interbody opening angles,and the percentage of slippage between two groups postoperative 12 months and preoperative 1 day(P＞0.05). ③There was no significant difference between two groups in VAS of low back pain at 3 days and 1,12 months after the operation compared with the preoperative(P＞0.05),but the VAS of the lower extremity pain was significantly improved compared with the preoperative(P＜0.05). Both of groups showed significant improvement in JOA score at 12 months compared with preoperatively(P＜0.05). There was no significant difference in VAS of low back pain,lower extremity pain and JOA scores between two groups during the same period after surgery(P＞0.05). According to modified Macnab criteria,excellent,good,fair and poor outcomes were 21,7,3 and 1 in transforaminal approach group respectively,and which in intervertebral approach group were 20,7,5 and 0,there was no significant difference in clinical effect between the groups(P＞0.05).
Conclusion Intervertebral approach may reduce intraoperative fluoroscopy times and transforaminal approach can shorten postoperative bedtime,both approaches achieve satisfactory results in the treatment of stable degenerative lumbar spondylolisthesis with no progression of short-term slippage. |
| KEY WORDS Spondylolysis Surgical procedures,endoscopic Surgical approach |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 陈启旺,陈馨卉,魏珂,吴海昊.两种入路经皮内镜手术治疗稳定型退变性腰椎滑脱症[J].中国骨伤,2023,36(1):48~54 |
| 英文格式: | CHEN Qi-wang,CHEN Xin-hui,WEI Ke,WU Hai-hao.Treatment of stable degenerative lumbar spondylolisthesis with percutaneous endoscopic surgery through two different approaches[J].zhongguo gu shang / China J Orthop Trauma ,2023,36(1):48~54 |
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