【摘要】 [目的]探讨经椎间孔脊柱内镜手术与开放椎板间开窗术治疗腰椎椎体后缘离断症(PRAS)的临床疗效。[方法]选择2016年9月~2018年9月收治的单节段、侧方型离断骨块的腰椎PRAS患者40例,其中经椎间孔脊柱内镜手术22例(内镜组),开放椎板间开窗手术18例(开放组)。记录两组围手术期资料。采用腰腿痛视觉模拟评分(VAS评分)、Oswestry功能障碍指数(ODI)和MacNab标准评定疗效。[结果]内镜组手术时间及术中透视次数多于开放组,切口长度、术中出血量、术后下地时间及住院天数均少于开放组(P<0.05)。内镜组术后出现1例患肢感觉异常,术中无转开放手术者,无椎间隙感染、神经根损伤、硬脊膜撕裂等术后并发症。开放组出现硬脊膜撕裂1例、患肢麻木感加重2例。两组术后腰腿痛VAS评分及ODI均较术前改善(P<0.05)。内镜组术后第1、7 d的腰痛VAS评分及术后第1 d的ODI要优于开放组(P<0.05),术后1和6个月腰痛VAS评分及ODI、术后各时间点腿痛VAS评分比较两组差异无统计学意义(P>0.05)。末次随访改良Macnab标准评价临床疗效,内镜组:18例优,2例良,2例可,优良率为90.91%;开放组:13例优,3例良,2例可,优良率为88.89%。[结论]经椎间孔脊柱内镜与开放椎板间开窗术治疗侧方型腰椎PRAS均能取得满意疗效。与开放手术比较,脊柱内镜手术具有创伤小、出血少、恢复快及并发症少等优点,具有良好的可行性、有效性、安全性及微创性。更多还原

【Abstract】 [Objective] To evaluate clinical outcomes of endoscopic surgery versus traditional open procedure for lumbar posterior ring apophysis separation(PRAS). [Methods] From September 2016 to September 2018, a total of 40 patients with lumbar PRAS were surgically treated. Of them, 22 patients underwent endoscopic surgery via percutaneous transforaminal approach, while the remaining 18 patients received traditional open procedure by lumbar lamina fenestration. The perioperative data were compared between the two groups, and clinical outcomes were evaluated by using visual analogue scale(VAS) for low back pain and leg pain, Oswestry disability index(ODI) and modified MacNab criteria. [Results] Although the endoscopic group consumed significantly longer operation time, associated with more frequent intraoperative fluoroscopy than the open group(P<0.05), the endoscopic group had statistically significantly shorter incision, less intraoperative bleeding, earlier ambulation and shorter hospitalization than the open group(P<0.05). Except postoperative dysesthesia in 1 patient, no complications, such as alternation to open procedure during operation, nerve root injuries and dural tear, happened in any patient of the endoscopic group. By contrast, dural tear in 1, deterioration of numbness in 2 patients occurred in the open group. The VAS scores of low back pain and leg pain, as well as ODI scores in both group significantly decreased over time(P<0.05), which proved significantly lower in the endoscopic group than the open group at early stage postoperatively(P<0.05), despite of the fact that they became insignificant at 1 and 6 months postoperatively(P>0.05). According to the modified MacNab criteria, the results were graded as excellent in 18, good in 2 and fair in 2 with the excellent and good rate of 90.9% in the endoscopic group, whereas excellent in 13, good in 3 and fair in 2 with the excellent and good rate of 88.9%in the open group at the latest follow up.[Conclusion] This endoscopic surgery via percutaneous transforaminal approach does achieve satisfactory results for lumbar PRAS, and has advantages of minimizing iatrogenic trauma and bleeding, improving recovery and reducing complications over the traditional open posterior surgery.更多还原