| 摘要: |
| 目的：探讨经皮椎板间入路内镜下椎管减压术治疗老年腰椎侧隐窝狭窄症的效果。方法：老年腰椎侧隐窝狭窄症患者 196 例，随机分为观察组和对照组各 98 例，观察组行经皮椎板间入路内镜下椎管减压术治疗，对照组行经皮椎间孔入路内镜下椎管减压术治疗。分别于术前和术后 7 d、1 个月、3 个月采用视觉模拟评分（VAS）法评估下肢疼痛程度， Oswestry 功能障碍指数（ODI）评定腰椎功能，采用侧隐窝角评估侧隐窝狭窄程度，依据 MacNab 标准评定手术效果，并记录手术并发症。结果：2 组术后 7 d、1 个月、3 个月 VAS 评分、ODI 评分均低于术前（P<0.05），且观察组均低于对照组（P<0.05）；观察组、对照组术后 7 d 软性侧隐窝角 [(30.53±9.76)?、(27.27±8.39)?]、骨性侧隐窝角 [(33.18±10.36)?、31.52±9.85)?] 均大于术前 [ 软性侧隐窝角 (14.26±7.92)?、(14.51±6.83)?，骨性侧隐窝角 (16.63±6.58)?、(17.02±7.73)?]（P<0.05），且观察组大于对照组（P<0.05）；术后 3 个月，观察组优良率（94%）与对照组（89%）比较差异无统计学意义（P>0.05）；2 组均未出现神经根撕裂、永久性神经损伤等严重并发症。结论：相较于经皮椎间孔入路，经皮椎板间入路镜下椎管减压术对减轻老年腰椎侧隐窝狭窄症患者下肢疼痛、改善侧隐窝狭窄及腰椎功能，效果更明显。 |
| 关键词: 腰椎侧隐窝狭窄症 内镜 椎管减压术 椎板间入路 老年 |
| DOI：10.3969/j.issn.1007-6948.2019.04.023 |
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| 基金项目: |
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| Effect of Percutaneus Endoscopic Interlaminar Decompression in Treatment of Lumbar Lateral Recess Stenosis in Elderly Patients |
| LI Zhi-da,XIE Jing-kai,PENG Xiao-mei |
| Department of Orthopaedics, Zhanjiang Lingnan Hospital, Zhanjiang Development Zone, Guangdong Province, Zhanjiang (524001), China;Department of Orthopaedics, Second People's Hospital of Foshan City, Guangdong Province (Foshan 528000) |
| Abstract: |
| Objective To investigate the clinical effect of percutaneus endoscopic interlaminar decompression in treatment of lumbar lateral recess stenosis in elderly. Methods Elderly patients with lumbar lateral recess stenosis (196 cases) were randomly divided into observation group and control group, 98 cases in each group. The observation group underwent percutaneus endoscopic interlaminar decompression. The control group underwent percutaneous endoscopic decompression. The degree of lower extremity pain was assessed by visual analogue scale (VAS) before surgery, 7 d, 1 month and 3 months after surgery. The Oswestry disability index (ODI) was used to assess lumbar function. The degree of crypt stenosis was assessed by crypt angle. The surgical outcomes of the two groups were assessed according to the MacNab criteria, and surgical complications were recorded. Results The VAS and ODI scores of the 2 groups were lower than those before operation (P<0.05) and observation group was lower than control group. Soft lateral crypt angle [(30.53±9.76)? and (27.27±8.39)?], skeletal lateral crypt angle [(33.18±10.36)? and 31.52±9.85)?] were greater than preoperative [soft side crypt angle: (14.26±7.92)?, (14.51±6.83)?; skeletal side crypt angle: (16.63±6.58)?, (17.02±7.73)?] (P<0.05), and the observation group was larger than the control group. The excellent rates of the observation group (94%) and control group ( 89%) were not significantly different (P > 0 . 05). There was no nerve root tear and serious complications such as permanent nerve injury in two groups. Conclusion Compared with percutaneous endoscopic decompression, percutaneus endoscopic interlaminar decompression is effective in reducing lower extremity pain and improving lateral recess stenosis and lumbar function in elderly patients with lumbar stenosis. |
| Key words: Lumbar lateral recess stenosis endoscopy spinal canal decompression interlaminar approach old age |
