两种入路脊柱内镜下磨钻治疗腰椎体后缘离断症△

Two kinds of endoscopic excision of apophyseal fragments with oscillating bur for lumbar posterior ring apophysis fracture

摘要:

[目的]比较经椎间孔内镜（transforaminal endoscopy, TE）与椎板间内镜（interlaminar endoscopy, IE）往复磨钻治疗腰椎后缘离断症的临床疗效。[方法] 回顾性分析本科 2016 年 4 月—2019 年 5 月使用脊柱内镜磨钻治疗的腰椎后缘离断症的 41 例患者。依据术前医患沟通结果，18 例采用 TE，另外 23 例采用 IE 进行减压，比较两组围手术期、随访和影像资料。[结果] 两组患者均顺利完成手术，术中无硬脊膜撕裂、神经损伤等并发症。TE 组的术中透视次数显著多于 IE 组 [(5.1±0.1) 次 vs (1.0±0.1) 次, P＜0.05]，两组手术时间、切口总长度、术中失血量、下地行走时间、住院时间的差异均无统计学意义 （P＞0.05）。 两组患者均随访 12 个月以上，随时间推移，两组 VAS 评分、ODI 评分显著减少（P＜0.05），相应时间点，两组间 VAS、ODI 评分的差异均无统计学意义 （P＞0.05）。影像方面，与术前相比，两组患者术后 12 个月椎管矢状径显著增大 （P＜0.05），而椎间隙高度无显著变化 （P＞0.05）；相同时间点，两组间上述影像指标的差异无统计学意义 （P＞0.05）。[结论] 两种入路内镜往复磨钻治疗腰椎体后缘离断症均是安全有效的微创方法，临床效果相当。

Abstract:

[Objective] To compare the clinical efficacy of transforaminal endoscopy (TE) versus interlaminar endoscopy (IE) used in excision of apophyseal fragments with oscillating bur for lumbar posterior ring apophysis fracture. [Methods] From April 2016 to May 2019, a total of 41 patients received endoscopic excision of apophyseal fragments with oscillating bur for lumbar posterior ring apophysis fracture. According to the results of preoperative doctor-patient communication, 18 patients were treated with TE, while the other 23 pa- tients were with IE for excision of apophyseal fragments by oscillating bur. The perioperative period, follow-up and imaging data of the two groups were compared. [Results] All patients in both groups had corresponding surgical procedures performed successfully without dural tear, nerve injury and other complications. The TE group had significantly greater number of intraoperative fluoroscopy than the IE group [(5.1±0.1) times vs (1.0±0.1) times, P＜0.05], despite statistically insignificant differences in operative time, total incision length, intraopera- tive blood loss, ambulation time and hospital stay between the two groups (P＞0.05). With time of the follow-up lasted for more than 12 months, the VAS and ODI scores in both groups were significantly reduced (P＜0.05), which were not significantly different between the two groups at any time points accordingly (P＞0.05). Radiographically, the spinal canal sagittal diameter was significantly enlarged (P＜0.05), whereas the intervertebral height remained unchanged in both groups 12 months after surgery compared with those preoperatively (P＞0.05), in addition, there was no significant difference in the above image indexes between the two groups at any time points accordingly (P＞0.05). [Conclusion] Both endoscopic excisions of apophyseal fragments with oscillating bur are safe, effective and minimally invasive methods for lumbar posterior ring apophysis fracture, with similar clinical outcomes.