单侧入路双侧减压与双侧棘突旁小切口入路双侧减压在腰椎管狭窄症内固定术患者中的应用效果比较
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摘要
目的研究比较单侧入路双侧减压与双侧棘突旁小切口入路双侧减压在腰椎管狭窄症内固定术患者中的临床应用效果。方法选择2015年1月～2017年1月四川省宜宾市第二人民医院收治的腰椎管狭窄症患者113例为研究对象,按患者手术方式不同分为观察组(n=60)和对照组(n=53),其中观察组采用单侧入路双侧减压术治疗,对照组采用双侧棘突旁小切口入路双侧减压术治疗。对两组患者的手术进行情况、并发症发生率、疼痛程度、腰椎功能等进行评价比较。结果观察组患者的手术时间、术中出血量、术后引流量、住院时间等指标均低于对照组(P <0.05)。观察组术后并发症发生率与对照组比较,差异无统计学意义(P> 0.05)。两组患者术后12个月视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)低于术前,且观察组患者术后12个月的VAS、ODI均低于对照组,差异均有统计学意义(P <0.05)。结论单侧入路双侧减压与双侧棘突旁小切口入路双侧减压术均能治疗腰椎管狭窄症,但单侧入路双侧减压术的创伤更小、术后恢复快,对术后疼痛程度和腰椎功能改善程度更好,值得进一步推广应用。
Objective To compare the clinical effect of bilateral decompression through unilateral approach and bilateral decompression through bilateral paracentric small incision in lumbar spinal stenosis patients. Methods From January 2015 to January 2017, the Second People′s Hospital of Yibin City were analyzed during the period of 113 patients with lumbar spinal stenosis disease as the research objects, and they were divided into observation group(n = 60) and control group(n = 53) according to the different surgical procedure, the observation group uses the unilateral approach bilateral decompression treatment, control group adopts double side beside the spine bilateral decompression treatment through small incision. The operative status, complication rate, pain degree and lumbar function of the two groups were evaluated and compared. Results The operation time, intraoperative blood loss, postoperative drainage volume, hospitalization time and other indicators in the observation group were all lower than those in the control group(P < 0.05).There was no significant difference in the incidence of postoperative complications between the observation group and the control group(P > 0.05). The visual simulation score(VAS) and Oswestry dysfunction index(ODI) at 12 months after surgery were lower in the two groups than those before surgery, and the VAS and ODI at 12 months after surgery in the observation group were lower than those in the control group, with statistically significant differences(P < 0.05).Conclusion Bilateral decompression through unilateral approach and bilateral decompression through bilateral paracentric small incision can both treat lumbar spinal stenosis, but bilateral decompression through unilateral approach has less trauma and faster postoperative recovery, and is better for postoperative pain and improvement of lumbar function,which is worthy of further promotion and application.
Objective To compare the clinical effect of bilateral decompression through unilateral approach and bilateral decompression through bilateral paracentric small incision in lumbar spinal stenosis patients. Methods From January 2015 to January 2017, the Second People′s Hospital of Yibin City were analyzed during the period of 113 patients with lumbar spinal stenosis disease as the research objects, and they were divided into observation group(n = 60) and control group(n = 53) according to the different surgical procedure, the observation group uses the unilateral approach bilateral decompression treatment, control group adopts double side beside the spine bilateral decompression treatment through small incision. The operative status, complication rate, pain degree and lumbar function of the two groups were evaluated and compared. Results The operation time, intraoperative blood loss, postoperative drainage volume, hospitalization time and other indicators in the observation group were all lower than those in the control group(P < 0.05).There was no significant difference in the incidence of postoperative complications between the observation group and the control group(P > 0.05). The visual simulation score(VAS) and Oswestry dysfunction index(ODI) at 12 months after surgery were lower in the two groups than those before surgery, and the VAS and ODI at 12 months after surgery in the observation group were lower than those in the control group, with statistically significant differences(P < 0.05).Conclusion Bilateral decompression through unilateral approach and bilateral decompression through bilateral paracentric small incision can both treat lumbar spinal stenosis, but bilateral decompression through unilateral approach has less trauma and faster postoperative recovery, and is better for postoperative pain and improvement of lumbar function,which is worthy of further promotion and application.
引文
[1]汤锋武,符锋,蒋显锋,等.经皮椎间孔镜单侧入路双侧减压治疗椎间盘突出致腰椎管狭窄症[J].中华神经外科杂志,2016,32(12):1234-1238.
[2]刘鹏,王爽,孙庆,等.微创单侧椎板入路双侧减压治疗老年腰椎管狭窄症的疗效[J].中国老年学杂志,2015,35(17):4935-4936.
[3]刘汉照,高占良.腰椎管狭窄症的致压因素及减压治疗效果[J].临床医学研究与实践,2018,3(32):77-79.
[4]胡伟,赵杰,巩陈,等.单侧椎板入路双侧减压治疗单侧症状为主腰椎管狭窄的疗效分析[J].中华医学杂志,2016,96(21):1673-1676.
[5]冯太山.经后路单侧椎板入路双侧减压椎间隙植骨融合内固定改良术治疗退变性腰椎管狭窄症的效果观察[J].河南医学研究,2017,26(15):2751-2752.
[6] Marle AV,Moojen WA,Arts MP,et al. Interspinous Process Devices versus Standard Conventional Surgical Decompression for Lumbar Spinal Stenosis:Cost Utility Analysis[J]. Spine J,2016,16(6):702-710.
[7]王智博,魏冬梅,袁旭芳,等.经后路单侧椎板入路双侧减压椎间隙植骨融合内固定改良术治疗退变性腰椎管狭窄症[J].医学理论与实践,2017,30(14):2103-2104.
[8] Franco P,Roberto P,Maria MPP,et al. Lumbar Interspinous Process Fixation and Fusion with Stand-Alone Interlaminar Lumbar Instrumented Fusion Implant in Patients with Degenerative Spondylolisthesis Undergoing Decompression for Spinal Stenosis[J]. Asian Spine J,2016,10(1):27-37.
[9]李强,赵永生,陈修福,等.经后路单侧椎板入路双侧减压椎间隙植骨融合内固定改良术治疗退变性腰椎管狭窄症临床研究[J].实用临床医药杂志,2017,21(23):191-192.
[10] Schenck C,Susante JV,Gorp MV,et al. Lumbar spinal canal dimensions measured intraoperatively after decompression are not properly rendered on early postoperative MRI[J]. Acta Neurochirurgica,2016,158(5):981-988.
[11]桂凯红,张海燕,黄林,等.微创单侧入路双侧减压固定与开放双侧减压固定治疗单间隙腰椎管狭窄症疗效比较[J].新乡医学院学报,2017,34(3):228-230.
[12]邓必权,胡华,滕宇,等.经后路单侧椎板入路双侧减压椎间隙植骨融合内固定改良术治疗退变性腰椎管狭窄症[J].中国临床研究,2017,30(3):306-309.
[13]黄开,杨金华.单侧入路双侧减压术和全椎板切除减压术治疗腰椎管狭窄症的临床疗效[J].江苏医药,2016,42(14):1576-1578.
[14]刘继波,李江龙,谢大伟,等.单侧入路扩大椎管减压与全椎板切除术治疗以单侧症状为主的腰椎管狭窄症的临床疗效[J].重庆医学,2017,46(29):4157-4159.
[15]张磊.经椎间孔单侧入路双侧减压融合内固定治疗腰椎管狭窄症[D].杭州:浙江大学,2017.
[16]姚羽,姜星杰,张烽,等.单侧入路双侧减压治疗腰椎管狭窄症的临床疗效[J].江苏医药,2015,41(19):2320-2322.
[17]任明亮,李辉,刘冬斌,等.显微内窥镜下单侧入路椎管扩大成形术治疗退变性腰椎管狭窄症的临床疗效研究[J].河北医学,2018,24(3):370-374.
[18]张磊,方向前,赵兴,等.经椎间孔单侧入路双侧减压融合内固定术治疗腰椎管狭窄症的近期疗效观察[J].中国修复重建外科杂志,2017,31(5):519-526.
[19]徐政,陈金传,刘艺.经皮椎间孔镜单、双侧入路双侧减压治疗退行性腰椎管狭窄症的短期疗效比较[J].山东医药,2018,23(1):81-83.
[20]徐清平,宋登峰,何剑星,等.微创单侧固定双侧减压在单节段腰椎管狭窄症患者中的效果分析[J].中华全科医学,2018,34(1):34-37.
[2]刘鹏,王爽,孙庆,等.微创单侧椎板入路双侧减压治疗老年腰椎管狭窄症的疗效[J].中国老年学杂志,2015,35(17):4935-4936.
[3]刘汉照,高占良.腰椎管狭窄症的致压因素及减压治疗效果[J].临床医学研究与实践,2018,3(32):77-79.
[4]胡伟,赵杰,巩陈,等.单侧椎板入路双侧减压治疗单侧症状为主腰椎管狭窄的疗效分析[J].中华医学杂志,2016,96(21):1673-1676.
[5]冯太山.经后路单侧椎板入路双侧减压椎间隙植骨融合内固定改良术治疗退变性腰椎管狭窄症的效果观察[J].河南医学研究,2017,26(15):2751-2752.
[6] Marle AV,Moojen WA,Arts MP,et al. Interspinous Process Devices versus Standard Conventional Surgical Decompression for Lumbar Spinal Stenosis:Cost Utility Analysis[J]. Spine J,2016,16(6):702-710.
[7]王智博,魏冬梅,袁旭芳,等.经后路单侧椎板入路双侧减压椎间隙植骨融合内固定改良术治疗退变性腰椎管狭窄症[J].医学理论与实践,2017,30(14):2103-2104.
[8] Franco P,Roberto P,Maria MPP,et al. Lumbar Interspinous Process Fixation and Fusion with Stand-Alone Interlaminar Lumbar Instrumented Fusion Implant in Patients with Degenerative Spondylolisthesis Undergoing Decompression for Spinal Stenosis[J]. Asian Spine J,2016,10(1):27-37.
[9]李强,赵永生,陈修福,等.经后路单侧椎板入路双侧减压椎间隙植骨融合内固定改良术治疗退变性腰椎管狭窄症临床研究[J].实用临床医药杂志,2017,21(23):191-192.
[10] Schenck C,Susante JV,Gorp MV,et al. Lumbar spinal canal dimensions measured intraoperatively after decompression are not properly rendered on early postoperative MRI[J]. Acta Neurochirurgica,2016,158(5):981-988.
[11]桂凯红,张海燕,黄林,等.微创单侧入路双侧减压固定与开放双侧减压固定治疗单间隙腰椎管狭窄症疗效比较[J].新乡医学院学报,2017,34(3):228-230.
[12]邓必权,胡华,滕宇,等.经后路单侧椎板入路双侧减压椎间隙植骨融合内固定改良术治疗退变性腰椎管狭窄症[J].中国临床研究,2017,30(3):306-309.
[13]黄开,杨金华.单侧入路双侧减压术和全椎板切除减压术治疗腰椎管狭窄症的临床疗效[J].江苏医药,2016,42(14):1576-1578.
[14]刘继波,李江龙,谢大伟,等.单侧入路扩大椎管减压与全椎板切除术治疗以单侧症状为主的腰椎管狭窄症的临床疗效[J].重庆医学,2017,46(29):4157-4159.
[15]张磊.经椎间孔单侧入路双侧减压融合内固定治疗腰椎管狭窄症[D].杭州:浙江大学,2017.
[16]姚羽,姜星杰,张烽,等.单侧入路双侧减压治疗腰椎管狭窄症的临床疗效[J].江苏医药,2015,41(19):2320-2322.
[17]任明亮,李辉,刘冬斌,等.显微内窥镜下单侧入路椎管扩大成形术治疗退变性腰椎管狭窄症的临床疗效研究[J].河北医学,2018,24(3):370-374.
[18]张磊,方向前,赵兴,等.经椎间孔单侧入路双侧减压融合内固定术治疗腰椎管狭窄症的近期疗效观察[J].中国修复重建外科杂志,2017,31(5):519-526.
[19]徐政,陈金传,刘艺.经皮椎间孔镜单、双侧入路双侧减压治疗退行性腰椎管狭窄症的短期疗效比较[J].山东医药,2018,23(1):81-83.
[20]徐清平,宋登峰,何剑星,等.微创单侧固定双侧减压在单节段腰椎管狭窄症患者中的效果分析[J].中华全科医学,2018,34(1):34-37.
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