Indications and clinical efficacy of spinal endoscopy in the treatment of
lumbar spinal stenosis
Abstract
Object: To evaluate the clinical characteristics, indications and clinical efficacy of spinal endoscopy in the treatment of lumbar spinal stenosis by comparison with the of open surgery.
Methods: 30 patients with degenerative lumbar spinal stenosis who underwent endoscopic approach from October 2015 to September 2016 were treated as minimally invasive group，including 13 males and 17 females with an average age of 56.60 ± 7.63.
30 patients with open surgery were lected as the control group by age,operative gment and follow-up time as matching factors. including 14 males and 16 females with an average age of 57.13 ± 7.58. The operative time, intraoperative blood loss, bedridden time, hospitalization time, cost and other related indexes were compared between the two groups.The two groups were evaluated by visual analogue scale (V AS) before, 1 day, 3 months and 6 months after operation, Preoperative, postoperative 1 month, 3 months, and 6 months were assd with the Oswestry disability index (ODI) and the modified MacNab criteria were ud to asss clinical efficacy.
Results: Minimally invasive group :The average age was 56.6 ± 7.63 years, the average operation time was 94.43 ± 14.4 min, the average intraoperative blood loss was 14.00 ± 4.98 ml, the average bedtime was 8.13 ± 0.73 h, the average hospital stay was 3.57 ± 0.57 days, the average hospitalization cost 20573.57 ± 1582.63 yuan, the average follow-up time of 9 .70 ± 1.73 months; Open group :The average age of the open group was 57.13 ± 7.58 years, the average operation time was 160.43 ± 12.05min, the average intraoperative blood loss was 268.67 ± 44.08 ml, the average bedtime was 73.77 ± 5.25h, the average hospital stay was 7.03 ± 0.81 days, the average hospitalization cost was 37890.50 ± 1044.19 The mean follow-up time was 9.81 ± 54 months. There was no significant difference in x, age and mean follow - up time between the minimally invasive group and the open group (P> 0.05). The average operative time, mean blood loss, average bedridden time, average hospitalization time and average hospitalization were better than tho in open group (P <0.05).All the patients in the two groups were successfully completed in all cas and follow-up according to regulations, followed up
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for 6 to 13 months. The V AS score and the ODI score were significantly lower in the two groups of patients during the same follow-up period (P <0.05). There was no significant difference in V AS scor
e, V AS score and ODI score between the two groups before surgery (P> 0.05). There were significant differences in V AS score, V AS score and ODI score between the two groups before and after operation (P <0.01). At the last follow-up, MacNab was ud to evaluate the postoperative curative effect. The excellent and good rate of minimally invasive group was 73.3% and the excellent rate of open group was 90.0%.
Conclusion: For patients with lumbar spinal stenosis, endoscopic approach by endoscopic surgery has the advantages of less trauma, shorter operative time, shorter hospitalization time, low cost. Endoscopic technique can obtain satisfactory therapeutic effect with limitations of lumbar spinal canal stenosis caud by lumbar disc herniation, epiphyal ring disruption and stenosis of various types of intervertebral foramen caud by thickening of ligamentum flavum and cohesion of the articular process. For patients with general anesthesia contraindications, we can try to u endoscopic surgery under local anesthesia. Although spine endoscope technology is developing rapidly, but the application of surgery for spinal stenosis in the difficult, For vere diffu stenosis of lumbar spinal canal, the effect of endoscopic surgery is not ideal, and the risk of decompression is not complete, and the overall efficacy is not as good as open surgery.
Graduate student: Tongtong Gu (Surgery)
Directed by Prof. Xuexiao Ma
Keywords: Spine; lumbar spinal stenosis; endoscopy; open surgery
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目 录
至尊散户引言 (1)
材料和方法 (3)
1一般资料 (3)
2纳入和排除标准 (3)
2.1病例纳入标准 (3)
2.2病例排除标准 (3)
3影像学检查 (4)
4手术方法 (4)
4.1手术器械 (4)
4.2手术操作方法 (4)
西周礼乐制度4.2.1微创组 (4)
4.2.2开放组 (5)
5术后处理 (7)
5.1微创组 (7)
5.2开放组 (7)
6观察指标及评价标准 (7)
7统计学方法 (8)
结果 (9)
感冒的症状
1临床特征 (9)
2围手术期临床特征 (9)
3疗效评价 (10)
3.1腰、腿痛V AS评分 (10)
3.2 ODI评分 (11)西南民族大学研究生院官网
3.3 MacNab疗效评价 (11)
4 典型病例 (12)
4.1 黄韧带肥厚所致腰椎管狭窄症 (12)
4.2 椎间孔型腰椎管狭窄 (13)
4.3 影像学表现与临床症状不符者 (15)
4.4 腰椎管狭窄合并腰椎间盘突出 (20)
4.5 骺环离断 (22)
讨论 (24)
结论 (26)
鞋博士加盟
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参考文献 (27)
综述 (30)
综述参考文献 (39)
攻读学位期间的研究成果 (43)
附录 (44)
附录（缩略词表） (43)
致谢 (46)板寸发型
学位论文独创性声明、学位论文知识产权权属声明 (47)
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引言
高三毕业寄语加盟代理合同引言
腰椎管狭窄症( lumbar spinal stenosis，LSS)是指由各种原因引起的骨质或纤维组织(腰椎椎体、关节突关节、椎板、黄韧带等) 增生肥厚，导致椎管或神经根管的狭窄，刺激或压迫相应的神经根或马尾神经而引起的一系列临床症状和体征[1] 。这个概念对深入了解腰椎管狭窄症的病理生理特点，明确分型和指导治疗有着重要的意义。腰椎管狭窄症的发病率在1.7％至8％之间，多见于50岁以上中老年人，发病率与性别无关[2]，与职业和生活习惯有关，病程缓慢，呈渐进性[3]，发病过程通常伴随着腰椎骨关节的退化[4-6]。
腰椎管狭窄症一般分为原发性与继发性，原发性腰椎管狭窄症多指发育不良而引起腰椎管狭窄症，如椎弓根短小、发育性椎板肥厚、椎体后缘或者小关节骨质肥大、两侧椎弓根距离变窄等。继发性腰椎管狭窄症由后天因素所引起，比如黄韧带松弛和肥厚、椎间盘向后侧突出、椎体后缘骨质增生、上下关节突骨质增生等。主要临床表现为腰背部疼痛，坐骨神经痛，间歇性跛行，下肢感觉障碍，肌力减
退，大小便障碍等等[7]。随着人口的老龄化的加剧和医学诊疗技术的发展，退行性腰椎管狭窄症的发病率居高不下，呈逐年增加的趋势[8]，现已经成为引起老年人腰腿痛的主要原因之一，严重影响患者的生活质量。部分患者经过保守治疗后症状可以得到缓解，但也有不少患者经正规保守治疗无效或症状反复发作。因此，手术便成为他们治疗的首选方法[9]。手术的主要目的是减压，解除神经根或者脊髓的压迫[10]。但是经典的手术减压过程破坏了脊柱稳定性，对患者的创伤比较大[11,12]。
随着微创技术的发展，尤其是脊柱内窥镜技术的发展，医生和患者都希望用微创技术来解决问题。脊柱内窥镜的应用范围也越来越宽，它不仅仅用来治疗腰椎间盘突出症，越来越多的医生尝试着运用脊柱内窥镜技术，去解决一部分特殊类型的腰椎管狭窄症。本文通过和开放手术各项相关指标对比，评价脊柱内窥镜技术治疗腰椎管狭窄症的技术特点、适应症和临床疗效。
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