| 摘要: |
| 目的 比较开放与通道下二种不同手术方式对腰椎管狭窄患者的治疗效果。方法:选择我院于2021年1月—2022年6月收治的腰椎管狭窄患者95例，依据手术方法分为开放组46例与通道组49例。开放组采用传统椎板切除减压内固定术，通道组采用固定通道技术治疗。两组患者均完成6个月随访。比较两组手术指标，术后并发症情况；术前和术后3 d患者疼痛介质和应激反应指标变化；术前、术后1个月和术后6个月腰痛和腿痛及腰椎功能变化。结果:通道组腰椎管狭窄患者术中出血量少于开放组，手术时间长于开放组，住院时间短于开放组(P＜0.05)。通道组腰椎管狭窄患者术后并发症发生率少于开放组(P＜0.05)。两组术后3 d腰椎管狭窄患者(Cor)和去甲肾上腺素(NE)水平高于术前(P＜0.05)；而通道组术后3 d腰椎管狭窄患者Cor和NE水平低于开放组(P＜0.05)。两组术后3 d腰椎管狭窄患者神经肽Y(NPY)和P物质(SP)水平高于术前，而β-EP水平低于术前(P＜0.05)；而通道组术后3 d腰椎管狭窄患者NPY和SP水平低于开放组，而β-内啡肽(β-EP)水平高于开放组(P＜0.05)。两组术后1个月和术后6个月腰椎管狭窄患者腰痛和腿痛视觉模拟评分(VAS)低于术前(P＜0.05)；通道组术后1个月和术后6个月腰椎管狭窄患者腰痛和腿痛VAS评分低于开放组(P＜0.05)。两组术后1个月和术后6个月腰椎管狭窄患者Oswestry功能障碍指数(ODI)低于术前(P＜0.05)；通道组术后1个月和术后6个月腰椎管狭窄患者ODI低于开放组(P＜0.05)。结论:相比于开放手术，固定通道技术治疗腰椎管狭窄患者效果好，并发症少，且可显著抑制疼痛介质释放，对应激反应影响小，显著减轻疼痛及显著改善腰椎功能。 |
| 关键词: 开放手术 固定通道技术 腰椎管狭窄 |
| DOI：10.3969/j.issn.1007-6948.2023.05.010 |
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| 基金项目:鹰潭市指导性科技计划项目(Ykz20180068) |
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| Comparison of the therapeutic effects of two different surgical methods for lumbar spinal stenosis |
| PAN Xiao-feng,ZHENG Neng-fang,WU Guang |
| Yingtan 184 Hospital Orthopedics Department Jiangxi Yingtan 335000,China |
| Abstract: |
| Objective To compare the therapeutic effects of two different surgical methods for lumbar spinal stenosis: open and channel. Methods The 95 patients with lumbar spinal stenosis admitted to our hospital from January 2021 to June 2022 divided into open group (46 cases) and access group (49 cases) according to the surgical methods. The open group was treated with traditional laminectomy, decompression and internal fixation, and the channel group was treated with fixed channel technology. Compare the two groups of patients who completed 6 months of follow-up. Operation indexes and postoperative complications of the two groups; changes of pain mediator and stress response index in patients before and 3 days after operation; low back pain and leg pain and lumbar function changes before, 1 month and 6 months after operation. Results The channel group amount of intraoperative bleeding of patients with lumbar spinal stenosis less than open group, the operation time longer than open group, and the hospitalization time shorter than open group (P<0.05). The channel group postoperative complications of patients with lumbar spinal stenosis less than open group (P<0.05). The two groups 3 days after operation levels of Cor and NE in patients with lumbar spinal stenosis higher than before operation (P<0.05); the channel group level of Cor and NE in patients with lumbar spinal stenosis lower than open group (P<0.05). The two groups 3 days after operation levels of NPY and SP in patients with lumbar spinal stenosis higher than before operation, while β- EP level lower than before operation (P<0.05); the channel group levels of NPY and SP in the patients with lumbar spinal stenosis lower than open group, while level of β-EP higher than open group (P<0.05). The two groups 1 month and 6 months after operation VAS scores of low back pain and leg pain in patients with lumbar spinal stenosis lower than before operation (P<0.05); the channel group VAS scores of low back pain and leg pain in patients with lumbar spinal stenosis lower than open group (P<0.05). The two groups 1 month and 6 months after operation ODI of low back pain and leg pain in patients with lumbar spinal stenosis lower than before operation (P<0.05); the channel group ODI of low back pain and leg pain in patients with lumbar spinal stenosis lower than open group (P<0.05). Conclusion Compared with open surgery, fixed channel technology for lumbar spinal stenosis has a better effect, fewer complications, and can significantly inhibit the release of pain mediators, have a small impact on stress response, significantly reduce pain and significantly improve lumbar function. |
| Key words: Open surgery fixed channel technology lumbar spinal stenosis |
