可视化椎间孔成形技术在脊柱内镜下治疗腰椎侧隐窝狭窄中的临床应用价值*

目的探讨可视化椎间孔成形技术在脊柱内镜下治疗腰椎侧隐窝狭窄的临床应用价值。方法收集该院2016年2月-2017年3月诊断为侧隐窝狭窄症患者共65例,经皮椎间孔脊柱内镜系统(TESSYS)组31例采用标准TESSYS技术行椎间孔成形,可视化组34例采用可视化椎间孔成形技术椎间孔成形,分别比较两组患者性别、年龄、病变节段、术中C臂透视次数、手术时间、手术相关并发症及临床效果,利用术前及术后各时段随访时患者腰痛和腿痛视觉模拟评分(VAS),末次随访时利用Macnab疗效评定标准评价患者临床疗效。结果两组患者性别、年龄及病变节段差异无统计学意义(P0.05),可视化组术中透视次数及手术时间明显低于TESSYS组,差异有统计学意义(P 0.05);两组患者术后腰痛及腿痛VAS评分较术前均明显降低,差异有统计学意义(P 0.05)。两组间术前及术后各时间点腰痛、腿痛VAS评分相比差异无统计学意义(P0.05)。根据Macnab疗效评定标准,两组患者末次随访时优良率比较差异无统计学意义(P0.05)。结论可视化椎间孔成形技术治疗腰椎侧隐窝狭窄症的近期临床疗效与标准TESSYS椎间孔成形技术相当,可视化椎间孔成形技术具有术中透视次数少、操作程序简化、手术时间短、安全、对腰椎关节稳定性干扰小的优势。

Clinical application of visualization foraminoplasty in treatment of lumbar lateral recess stenosis with endoscopic surgery*

Abstract: Objective?To explore the clinical application value of visualization foraminoplasty in treatment of lumbar lateral recess stenosis with endoscopic surgery.?Methods?65 patients with lateral recess stenosis diagnosed lumbar lateral recess stenosis from February 2016 to March 2017 were divided into two groups. 31 patients in the TESSYS group underwent Foraminoplasty with standard TESSYS technique, and 34 patients in visualized group underwent Foraminoplasty with visualization technique. The gender, age, lesion segments, intraoperative C-arm fluoroscopy frequency, operation time, surgical complications, and clinical outcomes were compared between the two groups. At the follow-up time, visual analog scale scores (VAS) were used for low back pain and leg pain. At the final follow-up, the clinical curative effect was evaluated using the Macnab efficacy evaluation criteria.?Results?There was no significant difference in gender, age, and diseased segments between the two groups (P?>?0.05). The number of fluoroscopy and operation time in the visualization group were significantly lower than those in the TESSYS group (P??0.05). According to the Macnab efficacy evaluation standard, there was no statistical difference in the excellent and good rate between the two groups at the final follow-up (P?>?0.05).?Conclusion?The short-term clinical efficacy of visual foraminoplasty in treatment of Lumbar Lateral Recess Stenosis is comparable to that of the standard TESSYS technique. Visual foraminoplasty has less intraoperative fluoroscopy times, simplified procedure, and shorter operation time, safety, and low interference with lumbar joint stability.