李鹏　　沈忠达

[關键词] 后外侧入路;临床疗效;单侧入路双侧减压技术;腰椎间盘突出症

[中图分类号] R681.5          [文献标识码] B          [文章编号] 1673-9701（2021）15-0073-04

Evaluation of clinical efficacy of bilateral decompression technique via the posterolateral approach（PELD） in the treatment of lumbar disc herniation and lumbar spinal stenosis

LI Peng   SHEN Zhongda

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

[Abstract] Objective To explore the clinical efficacy of bilateral decompression technique via the posterolateral approach （PELD） in treating lumbar disc herniation and lumbar spinal stenosis. Methods A total of 150 patients with lumbar disc herniation and lumbar spinal stenosis admitted to our hospital from December 2016 to December 2019 were collected. The medical records of all patients were recorded and retrospectively analyzed. All patients underwent bilateral decompression via posterolateral approach （PELD）. The patient's intraoperative blood loss， operation time， bed rest time， postoperative complications， ODI score， and VAS score were explored. Results The patient′s intraoperative blood loss was （44.72±4.16）mL， the operation time was（104.54±10.37）min， and the bed rest time was （7.57±1.62）d. Among patients with lumbar disc herniation and lumbar spinal stenosis， 2 cases developed intervertebral space infection，1 case developed dural sac rupture， 3 cases had incomplete decompression，and the postoperative complication rate was 4.00%. The patients were followed up for 15 days after symptomatic treatment， and they were all recovered. The ODI score and VAS score after the operation were lower than before the operation（P<0.05）. The patient′s low back pain score， sensory impairment score， walking ability score， leg pain score， daily life score， straight leg elevation test score， and hallux dorsi muscle strength score were higher than those before the operation， and the difference was statistically significant（P<0.05）. Conclusion The bilateral decompression technique via the posterolateral approach（PELD） has a relatively ideal treatment effect，which is of great significance for improving the relevantclinical symptoms of patients and reducing the incidence of complications.

[Key words] Posterolateral approach; Clinical efficacy; Bilateral decompression technique via unilateral approach; Lumbar disc herniation

腰椎管狭窄症与腰椎间盘突出症在我国临床属于多发的骨科疾病[1]。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[2]。常规手术虽能充分减压，但该手术方式术后并发症较多，如椎间隙感染、硬膜囊破裂等，且容易对患者脊柱后路结构造成破坏，易出现脊柱不稳情况，临床疗效尚不明显。随着内镜技术和微创手术的逐渐成熟与发展，经后外侧入路（Posterolateral approach，PELD）单侧入路双侧减压技术以微创的优越性广泛应用于临床相关疾病治疗中。根据相关临床报告指出，将经PELD单侧入路双侧减压技术治疗应用于腰椎管狭窄症及腰椎间盘突出症的临床治疗中，可获得满意的临床疗效[3]。有利于缩短患者的手术时长、减少术中出血量，改善患者的相关临床症状，减少并发症发生风险，进而提高临床疗效。国内外对于此类报道相对较少，依然缺乏临床依据。本研究中，对本院2016年12月至2019年12月收治的150例患者的临床效果展开研究和讨论，旨在研究后外侧入路（PELD）在治疗腰椎间盘突出症及腰椎管狭窄症中单侧入路双侧减压技术的临床疗效，现报道如下。

1 资料与方法

1.1 一般资料

选择本院2016年12月至2019年12月收治的腰椎间盘突出症及腰椎管狭窄症患者150例，记录与回顾性分析所有患者的病案情况，对全部患者均采用经后外侧入路（PELD）单侧入路双侧减压技术治疗。……