显微镜与显微内窥镜下手术治疗腰椎管狭窄症的疗效比较

摘要

Objective To compare the therapeutic effect of microscope-assisted with microendoscope decompression for the treatment of lumbar stenosis.Methods A prospective study was carried out and there were 275 cases of lumbar stenosis in this investigation.All cases were divided into two groups at random:the microscope-assisted group (137 cases) and microendo-scope group (138 cases).Operation time,operation information,curatire effect,complication and the stability of lumbar spine after operation were compared.261 patients were evaluated by ODI preoperative and 12 months postoperative,and by and bony union by fusion of intra-lumbar process fixation.All cases were followed the rate of general satisfaction to the operation as well.Results All cases had been successfully operated,8 cases in group B were turned to open operation.7 cases were suffered from rupture in each of two groups,which healed after corresponding treatment such as patch and compression packing.There were no other complications such as nerve root injury,infection.131 cases were followed up from 12 to 64 (30 ± 1.1) months except 6 cases in group A.130 cases were followed up from 12 to 66 (31 ± 1.5) months except 8 cases in group B.There were 4 cases suffered from spine instability in group B postoperative 5 years,which were achieved successful fusion.The standards Scoring System of Chinese Spinal Association (CSA) were used for investigation:The excellent and good rate was 93.1％ in group A and 91.5％ in group B.There was no significant differences between two groups (P＞0.05).Conclusions Both the two methods can obtain the same satisfied results of therapy and have show advantages of minimal invasion,less blood loss,short operation time,less complications,less breakage of posterior column of lumbar spine.%目的 比较显微镜与显微内窥镜下手术治疗腰椎管狭窄症的临床效果.方法 采用前瞻性研究方法,按同一标准选择275例腰椎管狭窄症患者,随机分为两组,A组采用显微镜下手术(137例),B组采用显微内窥镜下手术(138例).比较两组患者在手术时间、术中情况、疗效、并发症及腰椎稳定性等方面的指标.术前及术后12个月时应用ODI评分法对患者进行评定,并进行综合满意度评估.结果 B组有8例术中转为开放手术.两组术中各有7例发生硬脊膜破裂,予以修补、填塞压迫等相应处理后痊愈,术后无神经根损伤、感染等并发症.A组131例获随访,时间12 ～64(30±1.1)个月,6例失访；B组130例获随访,时间12 ～ 66(31±1.5)个月,8例失访.B组术后5年发生腰椎失稳4例,经腰椎间融合联合椎弓根螺钉内固定术治愈.根据中华医学会腰背痛手术评定标准评定疗效:A组优良率为93.1％,B组优良率为91.5％,两组差异无统计学意义(P＞0.05).结论 两种微创方法疗效均满意,均具有创伤小、出血少、手术时间短、并发症少、对腰椎后柱结构破坏小等优点.