摘要目的: 探讨Delta大通道脊柱内镜手术减压治疗腰椎椎管狭窄症的临床效果。方法: 本研究选取我院2021年1月至2022年1月收治的腰椎椎管狭窄症患者95例,其中48例患者采用Delta大通道脊柱内镜手术减压治疗(观察组)、另外47例患者采用单侧双通道脊柱内镜方式治疗(对照组),对比两组患者手术相关临床指标、手术前后的疼痛程度、Oswestry功能障碍指数(ODI)、椎管狭窄症CT影像学参数、临床疗效差异。结果: 观察组患者手术时间短于对照组,手术出血量小于对照组,差异具有统计学意义(P<0.05);两组患者的术后下地时间、住院时间比较,差异无统计学意义(P>0.05);术前,观察组和对照组患者的腰部疼痛VAS评分、腿部疼痛VAS评分比较,差异无统计学意义(P>0.05);两组患者术后,腰部及腿部疼痛程度明显减轻,VAS评分与术前比较显著降低(P<0.05);术前,观察组和对照组患者的腰椎间隙椎管矢状径(Sagittal diameter of spinal canal,APDC)、椎管面积(Spinal canal area ,CAC)、椎管内切圆面积(Area of vertebral canal ,ICA)、硬膜囊面积(Dural sac area ,CAD)和硬膜外间隙(Epidural space,LAC)测定值比较,差异均无统计学意义(P>0.05);两组患者术后3个月CT复查,显示患者的狭窄椎管得到很好的改善,腰椎间隙APDC、CAC、ICA、CAD、LAC测定值较本组术前显著的提高(P<0.05);术前,采用ODI对患者腰椎功能进行评价,观察组和对照组患者的ODI值差异均无统计学意义(P>0.05);两组患者术后腰椎功能得到明显的改善,ODI测定值较本组术前显著的降低(P<0.05);术后统计手术并发症,观察组为8.33%,对照组为4.26%,差异无统计学意义(P>0.05)。结论: Delta大通道脊柱内镜手术减压与单侧双通道脊柱内镜方式治疗腰椎椎管狭窄症均能取得良好的临床效果,但是前者的优势在于操作简单,所需手术时间及引起的手术出血量更少。
Abstract：Objective: To investigate the clinical effectiveness of Delta channel endoscopic spinal decompression in the treatment of lumbar spinal stenosis. Methods: A total of 95 patients with lumbar spinal stenosis admitted to our hospital from January 2021 to January 2022 were selected in this study. Among them, 48 patients were treated with Delta channel spinal endoscopic surgical decompression (observation group), and the other 47 patients were treated with unilateral double-channel spinal endoscopic treatment (control group). The differences of surgery-related clinical indicators, pain degree before and after surgery, Oswestry disability index (ODI), CT imaging parameters of spinal stenosis, and clinical efficacy were compared between the two groups. Results: The operation time of the patients in the observation group was shorter than that in the control group, and the operation bleeding volume was less than that in the control group, the difference was statistically significant (P<0.05). There was no statistically significant difference between the two groups in the postoperative time to the ground and hospital stay (P>0.05). Before operation, there was no significant difference in VAS score of waist pain and VAS score of leg pain between the observation group and the control group (P>0.05). After operation, the pain degree of waist and leg in the two groups was significantly reduced, and the VAS score was significantly lower than that before operation (P<0.05). Before operation, there was no statistically significant difference in the measured values of sagittal diameter of spinal canal (APDC), spinal canal area (CAC), area of vertebral canal (ICA), dural sac area (CAD) and epidural space (LAC) between the observation group and the control group (P>0.05); three months after operation, CT reexamination of patients in both groups showed that the stenosis of the spinal canal of the patients was improved very well, and the measured values of APDC, CAC, ICA, CAD and LAC in the lumbar intervertebral space were significantly higher than those in the group before operation (P<0.05); before operation, the lumbar function of the patients was evaluated by ODI. There was no significant difference in the ODI value between the observation group and the control group (P>0.05); the lumbar function of patients in the two groups was significantly improved after operation, and the measured value of ODI was significantly lower than that before operation (P<0.05). After operation, the postoperative complications were 8.33% in the observation group and 4.26% in the control group, with no significant difference (P>0.05). Conclusion: Both Delta channel endoscopic spinal decompression and unilateral double-channel endoscopic spinal decompression can achieve good clinical results in the treatment of lumbar spinal stenosis, but the former has the advantages of simple operation, less operation time, and less surgical blood loss.
梁旭, 吴建临, 李雅君, 赵艳东, 王文革. Delta大通道脊柱内镜手术减压治疗腰椎椎管狭窄症的有效性及安全性[J]. 河北医学, 2023, 29(6): 983-989.
LIANG Xu, WU Jianlin, LI Yajun, et al. Effectiveness and Safety of Delta Large Channel Endoscopic Spinal Decompression in the Treatment of Lumbar Spinal Stenosis. HeBei Med, 2023, 29(6): 983-989.
[1] Higuchi D,Yu K,Miki T.Patterns of physical activity and exercise after lumbar surgery among Japanese patients with lumbar spinal stenosis.[J].Journal of Physical Therapy Science,2021,33(2):146-152. [2] Lamas V,Gueugnon M,Fournel I,et al.Dynamic global sagittal alignment in patients with lumbar spinal stenosis:analysis of the effects of decompression surgery on gait adaptations[J].Gait & Posture,2021,88(8):272-279. [3] Kobayashi Y,Tamai K,Toyoda H,et al.Clinical outcomes of minimally invasive posterior decompression for lumbar spinal stenosis with degenerative spondylolisthesis[J].Spine,2021,46(18):1218-1225. [4] Li C,Ju F,Li W,et al.Efficacy and safety of unilateral biportal endoscopy compared with microscopic decompression in the treatment of lumbar spinal stenosis:a protocol for systematic review and meta-analysis[J].Medicine,2021,100(50):e27970. [5] Liang J,Lian L,Liang S,et al.Efficacy and complications of unilateral biportal endoscopic spinal surgery for lumbar spinal stenosis:a meta-analysis and systematic review[J].World neurosurgery,2022,159(8):e91-e102. [6] 边卫国,党晓谦,汤少杰,等.计算机辅助下腰椎CT图像自动化测量及其临床价值[J].中国脊柱脊髓杂志,2007,17(10):749-752. [7] 中华中医药学会整脊分会.中医整脊常见病诊疗指南[M].中国中医药出版社,2012. [8] 康立星,杨素梅,张鹏,等.单通道、单侧双通道和双侧三通道脊柱内镜技术对腰椎管狭窄症的临床疗效比较[J].川北医学院学报,2021,36(10):1323-1328. [9] 潘承波,孙健,李嗣生.Delta脊柱内镜系统下ULBD技术治疗单节段腰椎管狭窄症的早期疗效分析[J].中国骨与关节损伤杂志,2022,37(1):61-64. [10] 毕殿海,杨军,曾欢高,高叙军,廖勇,占欢腾,江平.关节镜下腰椎后路单边双通道内镜技术治疗腰椎间盘突出合并椎管狭窄症的临床观察[J].吉林医学,2022,43(6):1667-1669. [11] 王红建,吴志朋.脊柱单通道Delta内镜与单侧双通道内镜技术治疗老年性腰椎椎管狭窄症的比较[J].西安交通大学学报(医学版),2021,42(6):797-801. [12] 赵东东,徐峰,熊承杰,等.iLESSYS Delta与显微内镜下腰椎椎间盘切除术治疗腰椎管狭窄的疗效比较[J].华南国防医学杂志,2020,34(2):82-87.
2023, Vol. 29 
冀公网安备13080202000677号