| 谷艳超,朱凌,吉璐宏,等.自制微创拉钩辅助显微镜下单侧入路双侧减压治疗腰椎管狭窄症.骨科,2024,15(2): 97-103. |
| 自制微创拉钩辅助显微镜下单侧入路双侧减压治疗腰椎管狭窄症 |
| Self-made Minimally Invasive Hook Assisted Microscopy for Unilateral and Bilateral Decompression Treatment of Lumbar Spinal Stenosis |
| 投稿时间：2024-01-06 |
| DOI：10.3969/j.issn.1674-8573.2024.02.001 |
| 中文关键词: 腰椎 微创拉钩 显微镜 单侧入路双侧减压 椎管狭窄症 |
| 英文关键词: Lumbar Minimally invasive hook Microscope Bilateral decompression with unilateral approach Spinal stenosis |
| 基金项目:武汉市中医药科研面上项目（WZ22c08） |
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| 中文摘要: |
| 目的 探究自制微创拉钩配合显微镜单侧入路双侧减压治疗腰椎管狭窄症（LSS）的临床优势。方法 从2022年6月至2023年6月于我院诊断为LSS且需要手术治疗的238例病人中选取46例，随机分到自制微创拉钩配合显微镜单侧入路双侧减压手术组（观察组）和传统入路双侧减压手术组（对照组）。其中观察组男10例，女13例，年龄为（58.74±9.77）岁；对照组男11例，女12例，年龄为（60.65±7.99）岁。分别记录并比较两组病人手术时间、出血量、围手术期的C反应蛋白（CRP）和血清肌酸激酶（CK）、疼痛视觉模拟量表（visual analogue score，VAS）评分、Oswestry功能障碍指数（Oswestry disability index，ODI）、改良MacNab标准评分，以及手术前后椎管硬膜囊面积、椎间隙高度。结果 两组病人均顺利完成手术，术中无特殊原因改变手术病例；病人均获得随访，随访时间为（8.00±2.96）个月（4~13个月）。观察组术中出血量明显少于对照组[（148.70±42.35） mL vs. （215.22±60.14） mL]，差异有统计学意义（P＜0.05）。两组病人术后2天的CRP及CK值均较术前明显改善，且观察组较对照组更低[（7.32±0.92） mg/L vs. （11.35±1.59） mg/L，（237.70±45.64） U/L vs. （384.26±78.49） U/L]，差异有统计学意义（P＜0.05）。观察组和对照组术后2天、1个月、3个月的VAS评分、ODI均较手术前显著下降，差异有统计学意义（P＜0.05）；而且，两组间术后2天的数据比较，观察组较对照组更低[（2.78±0.67）分 vs. （4.04±0.82）分，14.96%±2.50% vs. 19.26%±4.32%]，差异有统计学意义（P＜0.05）。两组病人术后各个阶段的改良MacNab评分对比，差异无统计学意义（P＞0.05）。两组硬膜囊面积和椎间隙高度较术前均明显扩大，对照组术后2天、1个月的硬膜囊面积大于观察组[（160.92±7.17） mm2 vs. （148.86±8.59） mm2，（159.44±7.02） mm2 vs. （147.70±8.40） mm2]，差异有统计学差异（P＜0.05），两组术后椎间隙高度差异无统计学意义（P＞0.05）。结论 自制微创拉钩辅助显微镜下单侧入路双侧减压治疗LSS安全、有效，手术更加微创，出血更少，组织破坏更小，值得推广。 |
| 英文摘要: |
| Objective To investigate the clinical benefits of utilizing a self-made minimally invasive hook in conjunction with a microscope for unilateral and bilateral decompression in the management of lumbar spinal stenosis (LSS). Methods Totally, 46 patients diagnosed with LSS requiring surgical treatment were selected from a total of 238 patients in our hospital from June 2022 to June 2023. They were randomly assigned to either the experimental group, which underwent minimally invasive hook-assisted microendoscopic unilateral approach bilateral decompression surgery (observation group), or the control group, which underwent traditional bilateral decompression surgery. The observation group consisted of 10 male and 13 female patients with age of (58.74±9.77) years, while the control group had 11 male and 12 female patients with age of (60.65±7.99) years. The surgical time, amount of blood loss, perioperative levels of C-reactive protein (CRP) and serum creatine kinase (CK), visual analogue score (VAS), Oswestry Disability Index (ODI), modified MacNab criteria score, as well as the pre- and post-operative dural sac area and intervertebral space height were recorded and compared between the two groups. Results Both groups of patients underwent surgery smoothly, with no changes in surgical cases due to special reasons during the procedure. All patients were followed up for a period of (8.00±2.96) months (ranging from 4 to 13 months). The observation group had significantly less intraoperative blood loss than the control group [(148.70±42.35) mL vs. (215.22±60.14) mL] (P＜0.05). The postoperative CRP and CK levels in both groups at 2 days after surgery showed significant improvement compared to preoperative levels, with the observation group showing lower values than the control group [(7.32±0.92) vs. (11.35±1.59) mg/L, (237.70±45.64) vs. (384.26±78.49) U/L], and the difference was statistically significant (P＜0.05). The VAS scores and ODI in both groups at 2 days, 1 month, and 3 months postoperatively were significantly decreased compared to preoperative values, with statistical significance (P＜0.05). Additionally, when comparing the data at 2 days postoperatively between the two groups, the observation group had lower scores than the control group [2.78±0.67 vs. 4.04±0.82, 14.96%±2.50% vs. 19.26%±4.32%], and the difference was statistically significant (P＜0.05). There was no statistically significant difference in the modified MacNab scores at various postoperative stages between the two groups (P＞0.05). The dural sac area and intervertebral space height were significantly increased postoperatively compared to preoperative values in both groups. The dural sac area in the control group at 2 days and 1 month postoperatively was greater than that in the observation group [(160.92±7.17) vs. (148.86±8.59) mm2, (159.44±7.02) vs. (147.70±8.40) mm2], and the difference was statistically significant (P＜0.05), while there was no statistically significant difference in the intervertebral space height between the two groups postoperatively (P＞0.05). Conclusion The utilization of a self-designed minimally invasive hook-assisted approach under a microscope for unilateral approach bilateral decompression in treating LSS has been proven to be safe and effective. This surgical method is minimally invasive, resulting in reduced blood loss and minimal tissue damage, making it a promising technique worthy of wider adoption. |
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