【摘要】：目的:探討微創(chuàng)通道手術顯微鏡下單側入路雙側減壓術與傳統(tǒng)腰椎后路雙側椎板開窗減壓術治療腰椎管狹窄癥的療效對比及優(yōu)缺點。方法:回顧性分析2015年8月-2017年3月因單節(jié)段腰椎管狹窄癥患者采用微創(chuàng)通道手術顯微鏡下椎板開窗減壓術20例(微創(chuàng)組)和傳統(tǒng)腰椎后路雙側椎板開窗減壓術21例(傳統(tǒng)組)的手術時間、術中透視時間、出血量、術后并發(fā)癥、術前術后腰腿部視覺疼痛模擬評分(visual analogue scale,VAS)、Oswestry功能障礙指數(shù)(Oswestry disability index,ODI)評分及影像學資料評價2組手術治療效果。結果:1例傳統(tǒng)手術及2例微創(chuàng)手術術中出現(xiàn)硬膜撕裂,術中給予腦棉片、明膠海綿壓迫止腦脊液漏,術后予以切口嚴密縫合加壓包扎及抗生素預防感染,切口愈合良好,未出現(xiàn)明顯的并發(fā)癥。所有患者術后均給予至少六個月的隨訪,兩組患者術前常規(guī)資料及腰腿部VAS評分、腰椎ODI評分差異無統(tǒng)計學意義(P0.05)。微創(chuàng)組手術時間及術中透視時間多于傳統(tǒng)組,而傳統(tǒng)組術中出血量及術后引流量明顯多于微創(chuàng)組術中出血量(微創(chuàng)組術后未放置引流管,P0.05),微創(chuàng)組術后平均住院日少于開放組(P0.05)。與術前相比,兩組術后腰痛、腿痛VAS評分、ODI評分均降低(P0.05),兩組術后腿痛VAS評分及ODI評分比較無統(tǒng)計學意義(P0.05),但是微創(chuàng)組術后腰痛VAS評分低于開放組(P0.05)。臨床療效,微創(chuàng)組優(yōu)11例,良6例,可3例,差0例,微創(chuàng)組優(yōu)良率85.0%;傳統(tǒng)組優(yōu)13例,良5例,可3例,差0例,優(yōu)良率85.7%,兩組之間優(yōu)良率差異無統(tǒng)計學意義(P0.05)。結論:與傳統(tǒng)手術相比,微創(chuàng)通道手術顯微鏡下治療單節(jié)段腰椎管狹窄可以獲得良好的臨床效果,并且具有手術創(chuàng)傷小、出血量少、術后無需引流、并發(fā)癥少、康復時間短等優(yōu)點,值得進一步的臨床實踐推廣。
[Abstract]:Objective: to compare the curative effect and advantages and disadvantages of bilateral decompression with unilateral approach and traditional posterior laminectomy in the treatment of lumbar spinal stenosis. Methods: from August 2015 to March 2017, 20 cases (minimally invasive group) with laminectomy and decompression of bilateral laminae with traditional posterior approach for unilateral lumbar spinal stenosis were analyzed retrospectively. Operative time of 21 cases (traditional group), Intraoperative fluoroscopy time, bleeding volume, postoperative complications, preoperative and postoperative visual pain analogue score of waist and leg (visual analogue scale,VAS), Oswestry dysfunction index (Oswestry disability index,ODI) score and imaging data were used to evaluate the effect of operation in both groups. Results: 1 case of traditional operation and 2 cases of minimally invasive operation appeared dura tear. During the operation, they were treated with brain cotton slice, gelatin sponge compression and cerebrospinal fluid leakage. After operation, the incision was closely sutured and pressurized and bandaged with antibiotics to prevent infection. The wound healed well. There were no obvious complications. All patients were followed up for at least six months. There was no significant difference in preoperative routine data, lumbar VAS score and lumbar ODI score between the two groups (P0.05). The operative time and fluoroscopy time in the minimally invasive group were longer than those in the traditional group, while the intraoperative bleeding volume and postoperative drainage volume in the traditional group were significantly higher than those in the minimally invasive group (no drainage tube was placed in the minimally invasive group, P0.05). The average hospital stay in the minimally invasive group was less than that in the open group (P0.05). Compared with preoperative, the VAS score and ODI score of postoperative low back pain, leg pain in both groups were decreased (P0.05). The VAS score and ODI score of leg pain in the two groups were not statistically significant (P0.05). But the VAS score of postoperative low back pain in the minimally invasive group was lower than that in the open group (P0.05). The clinical effect was excellent in the minimally invasive group (n = 11), good in 6 cases, fair in 3 cases and poor in 0 cases. The excellent and good rate of the minimally invasive group was 85.0%. In the traditional group, 13 cases were excellent, 5 cases were good, 3 cases were fair, 0 cases were poor, and the excellent and good rate was 85.7%. There was no significant difference between the two groups (P0.05). Conclusion: compared with the traditional operation, the treatment of single-segment lumbar spinal stenosis under the microscope of minimally invasive channel surgery can obtain good clinical results, and has the advantages of less surgical trauma, less bleeding, less postoperative drainage and fewer complications. The advantages of short rehabilitation time are worthy of further promotion in clinical practice.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.3

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