李鹏　沈忠达

[摘要] 目的 研究脊柱內镜治疗腰椎管狭窄症中椎间孔入路和椎板间入路的减压范围和临床疗效。 方法 选取2016年12月至2019年12月本院收治的腰椎管狭窄症患者150例，随机分为对照组75例（采用脊柱内镜下椎间孔入路方式）与研究组75例（采用脊柱内镜下椎板间入路方式）。观察比较两组各项手术指征、ODI评分、VAS评分、术后末次随访MacNab优良率。 结果 研究组手术时间、卧床时间短于对照组，术中出血量少于对照组，差异有统计学意义（P<0.05）。术前两组ODI评分、VAS评分比较，差异无统计学意义（P>0.05）;研究组术后ODI评分、VAS评分低于对照组，差异有统计学意义（P<0.05）。研究组术后末次随访MacNab优良率为96.00%，高于对照组的86.67%，差异有统计学意义（P<0.05）。 结论 脊柱内镜下椎板间入路方式比椎间孔入路方式的作用更佳，对于缩短患者的手术时间、减少术中出血量、提高临床疗效等有十分重要的意义。

[关键词] 椎间孔入路;腰椎管狭窄症;减压范围;椎板间入路;脊柱内镜

[中图分类号] R681.5          [文献标识码] B          [文章编号] 1673-9701（2021）11-0062-04

Comparative analysis of decompression range and clinical efficacy of intervertebral foraminal approach and interlaminar approach in the treatment of lumbar spinal stenosis with spinal endoscopy

LI Peng   SHEN Zhongda

The Third Department of Orthopedics， Jiamusi Hospital of Traditional Chinese Medicine in Heilongjiang Province， Jiamusi   154002， China

[Abstract] Objective To study the decompression range and clinical effect of spinal endoscopy in the treatment of lumbar spinal stenosis. Methods A total of 150 patients with lumbar spinal stenosis admitted to our hospital from December 2016 to December 2019 were selected. All patients were divided into the control group 75 cases （with spine endoscopic intervertebral foraminal approach） and the study group 75 cases（using spinal endoscopic interlaminar approach）. The various surgical indications， ODI score， VAS score and the excellent and good rate of MacNab at the last follow-up after surgery between the two goups were observed and compared. Results The operation time and bed rest in the study group were shorter than the control group， the intraoperative blood loss was less than the control group， the differences were statistically significant （P<0.05）. There were no statistically significant differences in ODI score and VAS score of the two groups before treatment（P>0.05）. After treatment， the ODI score and VAS score of the study group were statistically significant lower than those of the control group（P<0.05）. The excellent and good rate of MacNab in the study group at the last follow-up after surgery was 96.00%， statistically significant higher than 86.67% in the control group （P<0.05）. Conclusion The method of interlaminar approach under spinal endoscopy has a better effect than the method of foraminal approach in this study. It is of great significance for shortening the operation time of patients， reducing intraoperative blood loss and improving clinical efficacy.

[Key words] Intervertebral foraminal approach; Lumbar spinal stenosis; Decompression range; Interlaminar approach; Spinal endoscopy

腰椎管狭窄症主要指因患者腰椎关节突内聚增生、后纵韧带钙化、小关节增生肥大及黄韧带肥厚等因素，造成腰椎形态、结构等出现异常变化，进而产生的一系列病症[1]。随着近些年来脊柱内窥镜设备的更新与技术的进步，适应证由最初的软性椎间盘突出，逐渐发展至腰椎管狭窄症，且取得了一定的临床效果。相关临床研究结果显示，将脊柱内镜下椎间孔入路方式与脊柱内镜下椎板间入路方式应用于腰椎管狭窄症的临床治疗中，可获得满意的临床疗效[2]。但因手术入路方式差异，其减压范围和临床疗效也存在一定的差异性，目前此方面的研究报道较少，仍缺乏相关临床依据。因此，本研究对150例腰椎管狭窄症患者进行研究和讨论，旨在探讨两种手术入路方式减压范围和临床疗效的差异，现报道如下。……