应用BEIS技术治疗腰椎管狭窄症的早中期疗效观察

目的:探讨经皮脊柱椎间孔镜下应用BEIS(Broad Easy Immediate Surgery)技术治疗腰椎管狭窄症的早中期临床效果。方法:对2013年6月至2016年6月手术治疗的57例腰椎管狭窄症患者的临床资料进行回顾性分析,其中32例患者采用椎间孔镜BEIS技术进行治疗(微创手术组),25例患者采用常规腰椎后路椎弓根螺钉内固定椎板切除椎间盘摘除椎间植骨融合手术进行治疗(开放手术组)。比较两组患者的手术时间、术中出血量及住院时间,分析两组患者术前和术后1周,1、3、6个月的VAS、ODI、JOA评分,评定两种手术方式的治疗效果。结果:所有患者顺利完成手术,住院期间无严重并发症发生,伤口均愈合良好,腰部及下肢疼痛症状术后均得到明显改善。57例患者均获得6个月以上的随访,平均随访时间为(10.65±3.38)个月。两组患者在年龄、性别、手术节段、BMI等一般资料方面差异无统计学意义(P0.05)。术后1周,1、3、6个月的VAS及ODI评分两组比较差异有统计学意义(P0.05),微创手术组在术后早中期对整体疼痛症状的改善及对腰部疼痛的改善优于开放手术组。而术后1周,1、3、6个月两组的JOA评分比较差异无统计学意义(P0.05),说明术后两组患者的整体功能状态差异无统计学意义。术中出血量及住院时间微创手术组明显少于开放手术组。结论:BEIS技术治疗腰椎管狭窄症与常规开放手术比较具有创伤小、出血量少等优势,它能更好的减轻术后早中期局部腰痛,早中期的治疗效果与开放手术相当,可以作为一种治疗腰椎管狭窄症安全有效的手术方式。

Early-middle stage effect of percutaneous spinal endoscopic BEIS technique for lumbar spinal stenosis

Objective:To explore the clinical early-middle stage clinical effect of percutaneous spinal endoscopic with the technique of Broad Easy Immediate Surgery(BEIS) for lumbar spinal stenosis.MethodsThe clinical data of 57 patients with lumbar spinal stenosis treated by surgery from June 2015 to June 2016 were retrospectively analyzed,including 32 cases treated by percutaneous spinal endoscopic with the technique of BEIS (minimally invasive group) and 25 cases by posterior approach of lumbar pedicle screws internal fixation and intervertebral disc excision with bone graft fusion surgery (open surgery group). The pre-operative general data such as age,Body Mass Index (BMI) and etc. were analysed and compared. The operation time,intraoperative blood loss,hospitalization time of the two groups were analyzed. Visual analogue score(VAS),Oswestry Disability Index(ODI),Japanese Orthopedic Association Score(JOA) of preoperative and at 1 week,1 month,3 months,6 months after surgery were used to evaluate the clinical outcome of the two group.ResultsAll the operations were successful and all the patients recovered smoothly without severe complications,all the wounds got good healing. The pain of the lumbar and lower limb had been improved after surgery. All the patients were followed up more than 6 months with an average of(10.65±3.38) months. There was no significant difference in general data such as age,BMI,and etc. between two groups(P>0.05). There were significant differences in VAS,ODI between two groups at 1 week,1,3,6 months after surgery(P<0.05). The postoperative lumbar pain of the minimally invasive group had been better improved than the open surgery group. However,there was no significant difference in JOA between two groups at 1 week,1,3,6 months after surgery(P>0.05). Intraoperative blood loss and hospitalization time of minimally invasive group was less than that of open surgery group.ConclusionBEIS technique has the advantage of less trauma,less bleeding for lumbar stenosis when compared to open surgery. It can better alleviate the postoperative local lumbar pain,and early-middle clinical effect is equivalent to open surgery,so it can be used as a safe and effective surgical treatment for lumbar spinal stenosis.