摘要
目的提出针对退行性腰椎管狭窄症(DLSS)"立体微创"治疗理念,并探讨其临床疗效。方法回顾性分析海军总医院疼痛诊疗中心采用"立体微创"治疗47例DLSS患者的临床资料。联合应用射频、臭氧、针刀等治疗技术,针对DLSS腰椎前、中、后柱不同部位,予以微创治疗。所有患者定期进行随访,分别于6个月及末次随访进行疗效评估,记录视觉模拟VAS量表、腰椎疾患JOA评分、Oswestry功能残障量(ODI)表及SF-36生活质量量表评定分值,比较不同时点的治疗结果,并计算临床治疗有效率。结果平均随访(14.4±8.4)个月,术后6个月治疗总有效率为91.49%,末次随访治疗总有效率达89.36%。随访显示VAS、JOA、ODI及SF-36分值均能维持在较满意水平,与术前相比有统计学差异(P<0.05)。临床症状改善满意,腰腿疼痛缓解、生活质量改善、社会活动适应性增加,无严重并发症发生。结论 "立体微创"治疗DLSS疗效肯定,安全可靠,拓宽了脊柱微创手术的临床适应证,值得推广。
ObjectiveTo put forward the treatment concept of “three-dimensional minimally invasive （TDMI）” therapy aiming at degenerative lumbar spinal stenosis （DLSS）, and meanwhile, to explore the related clinical outcome.Methods A retrospective study was conducted. Forty-seven patients with DLSS were treated with TDMI therapy. Combining with radiofrequency, oxygen-ozone and needle knife techniques, we performed minimally invasive surgery against the different sites of the anterior, middle and posterior column of the lumbar spine. All patients were followed-up regularly, and the clinical efficiency was evaluated at both six months after the surgery and the final time point. Scores of Visual Analogue Scale （VAS）, JOA, Oswestry Disability Index （ODI） and SF-36 were calculated and recorded. These scores at different time points were analyzed and compared, and also, the clinical treatment efficiency was calculated.Results The mean follow-up period was （14.4±8.4） months. The total effective rate was 91.49% at six months after TDMI surgery, while was 89.36% at the final follow-up. The follow-up data showed that the scores of VAS, JOA, ODI and SF-36 could maintained at a well-pleasing level, which presented significant difference compared with the scores preoperatively（P〈0.05）. The clinical outcome was satisfied, with the improvement of low back and leg pain, quality of the daily life and adaptability of the social activity. No serious complication occurred.ConclusionTDMI therapy has a positive effect in patients with DLSS. It broadens the clinical indications for minimally invasive spine surgery, which is safe, reliable and worthy of promotion.
出处
《中华临床医师杂志（电子版）》
CAS
2014年第13期73-78,共6页
Chinese Journal of Clinicians(Electronic Edition)
基金
北京市科学技术委员会"首都临床特色应用研究"专项课题(Z131107002213058)
关键词
椎管狭窄
外科手术
微创性
治疗结果
退行性
Spinal stenosis
Surgical procedures,minimally invasive
Treatment outcome
Degenerative
作者简介
通讯作者：丁宇，Email：cosmos_dingyu@163．ocm
