经皮椎间孔镜下腰椎管前方和侧方减压治疗腰椎管狭窄症的疗效观察

目的 探讨经皮椎间孔镜下腰椎管前方和侧方减压治疗腰椎管狭窄症的临床疗效。 方法 选取2016年6月—2017年9月南通市中医院和启东市中医院收治腰椎管狭窄患者60例，男性37例，女性23例，年龄61~79岁。按随机数字表法分为2组，观察组30例，平均年龄(62.1±2.7)岁，平均病程(4.7±2.1)年；对照组30例，平均年龄(63.7±3.2)岁，平均病程(5.1±2.6)年。观察组采用内镜下腰椎管前方和侧方减压，对照组采用传统手术治疗。记录2组患者的手术时间、术中出血量、住院天数，通过疼痛视觉模拟评分(visual ana-logue scale,VAS)及Oswestry功能障碍指数(Oswestry disability index,ODI)评估临床疗效。 结果 观察组患者手术时间、术中出血量、住院时间明显低于对照组，2组比较差异均有统计学意义(均P＜0.01)。术后第1天、1个月、3个月、6个月，观察组腰痛、腿痛VAS评分明显低于对照组，差异有统计学意义(均P＜0.01)。术后1、3、6个月时观察组ODI(%)评分明显低于对照组，差异有统计学意义(均P＜0.01)。 结论 经皮椎间孔镜下腰椎管前方和侧方减压手术具有创伤小、恢复快、疗效明确等优点，是治疗老年性腰椎管狭窄症较好的手术方式。 

Treatment of lumbar spinal stenosis with percutaneous transforaminal endoscopic discectomy via anterior and lateral approach

Objective To study the curative effect of percutaneous transforaminal endoscopic discectomy (PTED) via anterior and lateral approach in the treatment of senile lumbar spinal stenosis. Methods A total of 60 patients with lumbar spinal canal stenosis were enrolled and randomly divided into two groups with 30 cases in each group. PTED was performed in the observation group, while the conventional surgical treatment was performed in the control group. The operation time, intraoperative bleeding volume and the length of stay of the two groups were documented. The visual ana-logue scale (VAS) and Oswestry disability index (ODI) were used to evaluate the clinical efficacy. Results The operation time, intraoperative bleeding volume and length of stay in the observation group(66.93 ±7.31) min, (25.97±7.29) ml, and (3.07±0.64) days, respectively, which was effectively lower as compared with the control group. The total ODI score at 1, 3 and 6 months in the observation group was (29.93±3.54), (18.77±3.05) and (9.10±3.17), respectively, which was shorter than those in the control group, the difference was statistically significant (all P<0.05). Conclusion PTED via anterior and lateral approach, with advantages of small trauma, quick recovery and clear curative effect, is one of good surgery for the senile lumbar spinal stenosis disease.