摘要
[目的]对比显微镜下精准减压术(microscope-assisted precise decompression,MPD)与传统椎板切除减压术(traditional laminectomy decompression,TLD)治疗单节段退变性腰椎管狭窄症(degenerative lumbar spinal stenosis,DLSS)的临床效果,评估MPD治疗DLSS的可行性。[方法]回顾分析2007年3月～2009年3月本院收治的82例单节段DLSS患者,其中采取TLD治疗43例,采取MPD治疗39例。比较两种手术方法的手术时间、术中出血量、术后引流量、切口长度、术后3 d内最高体温以及术后外周血的白细胞和C反应蛋白的动态变化。采用ODI和VAS评价临床治疗效果。[结果]两组的手术时间无显著性差异(P>0.05)。与TLD组相比,MPD组术中出血量和术后引流量更少、切口更小、术后3 d内的最高体温较低、以及术后24 h外周血的白细胞和C反应蛋白的平均值较低,差异有显著性(P<0.01)。在VAS和ODI评分方面,两组术后6个月和末次随访时均较术前明显改善(P<0.01),术后6个月两组间的比较无显著性差异(P>0.05),而末次随访时MPD组优于TLD组(P<0.01)。末次随访时,TLD组优18例,良15例,可7例,差3例,优良率为76.7%;MPD组优27例,良9例,可3例,差0例,优良率92.3%,MPD组的临床疗效优于TLD组(P<0.05)。末次随访时,11例TLD及3例MPD患者出现手术节段失稳,TLD手术节段失稳发生率高于MPD组(P<0.05)。[结论]短期内,两种方法治疗单节段DLSS均可获得充分的减压及良好的临床效果;与TLD相比,MPD具有术中出血量和术后引流量少、手术切口小、术后全身炎性反应轻、手术对腰椎稳定性负面影响小以及远期的临床疗效更好的优势。
[Objective]To compare the clinical outcomes of microscope-assisted precise decompression（MPD） and traditional laminectomy decompression（TLD） for treatment of single-level degenerative lumbar spinal stenosis（DLSS） and to evaluate the feasibility of MPD for treatment of single-level DLSS.[Methods]A retrospective study was carried out on 82 patients with single-level DLSS admitted to our haspitad between March 2007 and March 2009.Forty-three patients were treated with TLD,and the other 39 patients were treated with MPD.The duration of surgery,intraoperative blood loss,postoperative drainage,length of incision,highest peak temperature within 3 days postoperativel y,dynamic change of leucocyte and C reactive protein in peripheral blood were compared between groups.The clinical outcomes were evaluated according to Oswestry Disability Index（ODI） and Visual Analogue scores（VAS）.[Results]There was no difference with respect to duration of surgery between groups.Compared with TLD group,results of less intraoperative blood loss and postoperative drainage,smaller incisions,lower peak temperature within 3 days postoperatively,lower mean value of leucocyte and C reactive protein in peripheral blood at 24 hours postoperatively were achieved in MPD group（P0.01）.VAS and ODI were significantly improved at 6 months after operation and at the last follow-up in both group（P0.01）.Differences were not significant（P0.05） between groups at 6 months after operation,but more significant in the MPD group at the last follow-up（P0.05）.At the last follow-up,results of overall satisfaction in TLD group were excellent in 16,good in 15,fair in 7 and poor in 3 patients,with the excellent and good rate of 76.7%.While in MPD group results of overall satisfaction were excellent in 27,good in 9,fair in 3 and poor in 0 patients,with the excellent and good rate of 92.3%.Higher excellent and good rate were achieved in MPD group（P0.05）.Eleven patients developed instability of surgical segment in 11 cases of TLD group but 3 patients in MPD group at the last follow-up.The incidence rate of instability was wigher in TLD group.[Conclusion]In short term,adequate decompression and good clinical outcomes can be achieved in both MPD and TLD group for treatment of single-level DLSS.Compared with TLD,MPD had advantages of less intraoperative blood loss and postoperative drainage,smaller incisions,lighter postoperative systemic inflammatory response,lighter postoperative negative impact on the stability of lumbar spine and better long-term clinical outcomes.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2012年第5期397-401,共5页
Orthopedic Journal of China
关键词
显微镜下精准减压术
传统椎板切除减压术
退变性腰椎管狭窄症
microscope-assisted precise decompression
traditional laminectomy decompression
degenerative lumbar spinal stenosis
