摘要目的 探讨通道椎旁入路显微镜椎管减压术与传统半椎板入路手术在治疗腰椎椎管狭窄症的疗效分析.方法 回顾性分析2015年5月至2018年6月在解放军总医院第一医学中心神经外科收治的56例腰椎椎管狭窄症患者的临床资料.收集患者性别、年龄、手术时间、术中出血量及术后卧床时间和住院时间.将56例患者分成通道椎旁入路组(n=35)和传统半椎板入路组(n=21)两组手术,通过日本骨科学会(JOA)评分和视觉模拟量表(VAS)评分,评价患者术前、术后1周、术后1个月、术后6个月和末次随访的功能情况.结果 通道椎旁入路组在手术时间(83.1 min±7.3 min)、出血量(18.2 ml±3.9 ml)、卧床时间(37.4 h±7.8 h)及住院时间(3.8±1.1)d,显著优于半椎板入路组[手术时间(86.1±9.6) min、术中出血量(40.5±13.3) ml、卧床时间(63.7±15.8)h及住院时间(6.5d±2.0)d],P＜0.05;通道椎旁入路组术后1周、术后1个月和术后6个月时JOA评分分别为21.8±3.4、23.6±2.4及24.2±2.4,显著高于半椎板入路组(分别为19.9±3.7、21.6±2.8及22.4±2.1),P＜0.05;通道椎旁入路组,术后1周、术后1个月和术后6个月VAS评分2.2±1.0、2.0±1.1及0.4±0.1,低于半椎板入路组(分别为3.1±1.2、2.6±1.3及0.5±0.1),P＜0.05;在末次随访时,两组JOA评分和VAS评分差异无统计学意义(P＞0.05).结论 在非融合微创手术治疗腰椎椎管狭窄症中,通道椎旁入路出血量更少、卧床及住院时间更短,短期内临床症状缓解优于传统半椎板入路,长期随访时两种入路预后均满意.

abstractsObjective To analysis of the efficacy of tubular paraspinal approach and conventional semi-laminar approach in treating lumbar stenosis.Methods Retrospective research of clinical data of 56 lumbar stenosis cases who were operated in neurosurgery department of first center of PLA general hospital from May 2015 to June 2018.Collecting the information of sex,age,operating time,intraoperative blood loss,postoperative duration in bed,as well as length of hospital stay of those patients.The 2 groups of cases,tubular paraspinal approach group (n=35)and semi-laminal approachgroup (n=21),compared by Japanese orthopedic association (JOA) score and visual analogue scale to assess the functional situation of the patients before operation,1 week after operation,1 month after operation,6 months after operation,and the last follow up.Results The operating time(83.1 ±7.3 vs 86.1 ±9.6 min),intraoperative blood loss(18.2±3.9 vs 40.5± 13.3 ml),postoperative duration in bed(37.4±7.8 vs 63.7± 15.8 h),as well as length of hospital stay (3.8± 1.1 vs 6.5±2.0 d)were all obviously better in tubular paraspinal approach group than in traditional semi-laminar approach group(P＜0.05).The postoperative 1 week,1month,and 6 months JOA score (21.8±3.4,23.6±2.4,24.2±2.4 vs 19.9±3.7,21.6±2.8,22.4±2.1)and VAS (2.2±1.0,2.0±1.1,0.4±0.1vs 3.1 ± 1.2,2.6± 1.3,0.5±0.1) were better in tubular paraspinal approach group than semi-laminar approach group (P＜0.05).While at the last follow up,the JOA score and VAS were similar in the 2 groups(P＞0.05).Conclusions In non-fusion techniques for treating lumbar stenosis,tubular paraspinal approach demonstrated less blood loss,shorter stay in bed as well as in hospital,and better symptom relief in early postoperative period than traditional semi-laminal approach.While at long term follow up,both approaches achieved satisfactory outcome.