【摘要】 目的 比较数字3D技术辅助与传统方式单孔分体内镜手术治疗腰椎管狭窄症合并退行性脊柱侧弯(lumbar spinal stenosis with degenerative scoliosis, LSS-DS)的临床疗效。方法 回顾性分析2022年1月～2023年12月42例LSS-DS行单孔分体内镜手术的临床资料，其中采用数字3D技术辅助单孔分体内镜手术20例(3D组),传统单孔分体内镜手术22例(传统组),比较2组手术时间、术中出血量、外侧关节面保留率、下肢疼痛视觉模拟评分(Visual Analogue Scale, VAS)、Oswestry功能障碍指数(Oswestry Disability Index, ODI)及末次随访改良MacNab疗效标准。结果 2组患者均顺利完成手术。3D组与传统组手术时间分别为(73.3±24.0)、(65.7±23.8)min,差异无显著性(t=1.020,P=0.314);术中出血量分别为(65.3±14.7)、(66.7±17.1)ml,差异无显著性(t=-0.298,P=0.767)。外侧关节面保留率3D组(88.2±6.3)%,明显高于传统组(82.7±4.6)%(t=3.201,P=0.003)。传统组1例发生硬膜撕裂，经保守治疗后痊愈；3D组3例小腿肌间静脉血栓形成，传统组4例，均给予药物抗凝治疗并适当推迟下地活动时间。3D组20例随访6～13个月，(8.2±2.0)月；传统组22例随访6～12个月，(7.7±1.7)月。末次随访3D组与传统组改良MacNab标准优良率分别为95.0%(19/20)、90.1%(20/22),2组差异无显著性(Z=-0.311,P=0.756)。2组患者术后3、6个月下肢疼痛VAS评分和ODI均较术前明显改善(均P=0.000),但2组间比较差异无显著性(P>0.05)。结论 数字3D技术辅助下单孔分体内镜手术治疗LSS-DS短期疗效确切，患者症状改善明显。更多还原

【Abstract】 Objective To compare the clinical efficacy of digital 3D technology assisted and traditional one-hole split endoscopic surgery for lumbar spinal stenosis with degenerative scoliosis(LSS-DS). Methods Clinical data of 42 patients with LSS-DS who underwent one-hole split endoscopic surgery from January 2022 to December 2023 were retrospectively analyzed. Among them, 20 cases were treated with digital 3D technology assisted one-hole split endoscopic surgery(3D group), and 22 cases were treated with traditional one-hole split endoscopic surgery(traditional group). The operation time, intraoperative blood loss, lateral articular surface preservation rate, Visual Analogue Scale(VAS) of lower extremity pain, Oswestry Disability Index(ODI) and modified MacNab criteria at the last follow-up were compared between the two groups. Results Both groups of patients were operated successfully. The operation time of the 3D group and the traditional group was(73.3±24.0) min and(65.7±23.8) min, respectively, with no significant difference(t=1.020, P=0.314). The intraoperative blood loss was(65.3±14.7) ml and(66.7±17.1) ml, respectively, with no significant difference(t=-0.298, P=0.767). The retention rate of lateral articular surface in the 3D group [(88.2±6.3)%] was significantly higher than that in the traditional group [(82.7±4.6)%, t=3.201, P=0.003]. One patient in the traditional group had dural tear and was cured after conservative treatment. There were 3 cases of calf muscle venous thrombosis in the 3D group and 4 cases in the traditional group. All the 7 patients were given anticoagulant therapy and appropriately delayed time of ambulation. In the 3D group, 20 cases were followed up for 6-13 months, with a mean of(8.2±2.0) months; in the traditional group, 22 cases were followed up for 6-12 months, with a mean of(7.7±1.7) months.According to the modified MacNab criteria, the excellent and good rate was 95.0%(19/20) in the 3D group and 90.1%(20/22) in the traditional group at the last follow-up, and there was no significant difference between the two groups(Z=-0.311, P=0.756). The VAS score and ODI of the two groups were significantly improved at 3 months and 6 months after operation(all P=0.000), but there was no significant difference between the two groups at each time point(P>0.05). Conclusion The short-term efficacy of digital 3D technology assisted one-hole split endoscopic surgery in the treatment of LSS-DS is definite, and the symptoms of patients are significantly improved.更多还原