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| Application Value of Microscope and Foraminoscope in Lumbar Canal Decompression and Interbody Fusion for Patients with Degenerative Lumbar Spinal Stenosis |
| QIE Weiguo, SUN Yibao, DUAN Guoqiang, et al |
| Department of Orthopedics Ⅰ, Ruzhou People's Hospital, Ruzhou Henan 467599 |
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Abstract 【Objective】 To explore the application value of microscope and foraminoscope in transforaminal lumbar interbody fusion (TLIF) for patients with degenerative lumbar spinal stenosis (DLSS). 【Methods】 The clinical data of 82 DLSS patients admitted to our hospital from March 2021 to March 2023 were retrospectively analyzed. According to different surgical methods, they were divided into control group (TLIF under microscope) and observation group [TLIF under foraminoscope (E-TLIF)], with 41 cases in each group. Perioperative indicators, pain mediator levels, inflammatory stress levels, total incidence of postoperative complications, and lumbar function recovery were compared between the two groups. 【Results】 The incision length, operation time, and hospital stay in the observation group were shorter than those in the control group, and the blood loss was less than that in the control group (P<0.05). At 12 h, 24 h, and 48 h after surgery, the visual analogue scale (VAS) scores of the two groups were lower than those before surgery (P<0.05), and the observation group was lower than the control group (P<0.05). After surgery, the levels of substance P (SP), prostaglandin E2 (PGE2), neuropeptide Y (NPY), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), monocyte chemoattractant protein (MCP-1), and malondialdehyde (MDA) in both groups were higher than those before surgery, but the observation group was lower than the control group (P<0.05). There was no significant difference in the total incidence of complications between the two groups (P>0.05). At 6 months and 12 months after surgery, the Oswestry Disability Index (ODI) scores of the two groups were lower than those before surgery, and the Japanese Orthopedic Association (JOA) scores were higher than those before surgery (P<0.05), but there was no significant difference in ODI scores and JOA scores between the two groups at 6 months and 12 months after surgery (P>0.05). 【Conclusion】 Both E-TLIF and microscope-assisted TLIF can promote the recovery of lumbar function in DLSS patients, but E-TLIF can reduce operation time and blood loss, alleviate pain and inflammatory stress, and cause less trauma to the body.
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Received: 22 July 2024
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[1] 李雪鹏, 宋成, 桑平, 等. 传统后路椎管减压融合术与电子显微镜下微创术治疗退变性腰椎管狭窄症的疗效比较[J].实用医学杂志, 2020,36(22):3088-3093.
[2] 刘兵兵, 任志楠, 张盼可, 等. 经皮内镜与微创经椎间孔腰椎间融合术治疗单节段退行性腰椎管狭窄的疗效对比[J].中国微创外科杂志, 2022,28(7):553-558.
[3] 梁海峰, 陆顺一, 刘书豪, 等. 高龄腰椎管狭窄症患者的手术方式选择及疗效[J].中国脊柱脊髓杂志, 2018,28(8):705-712.
[4] 郑明军, 蒋臻, 张植雄, 等. 经皮椎间孔镜技术与显微镜辅助治疗腰椎间盘突出症的临床疗效分析[J].中国内镜杂志, 2023,29(4):13-18.
[5] SCHIZAS C, THEUMANN N, BURN A, et al. Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images[J].Spine (Phila Pa 1976),2010,35(21):1919-1924.
[6] 孙兵, 车晓明. 视觉模拟评分法(VAS)[J].中华神经外科杂志, 2012,28(6):645.
[7] 程继伟, 王振林, 刘伟, 等. Oswestry功能障碍指数的改良及信度和效度检验[J].中国脊柱脊髓杂志, 2017,27(3):235-241.
[8] 孙兵, 车晓明. 日本骨科协会评估治疗(JOA评分)[J].中华神经外科杂志, 2013,29(9):969.
[9] 李海涛, 梁栋华. Quadrant通道椎体间融合与TLIF术治疗退行性腰椎侧弯合并腰椎管狭窄症效果观察[J].海南医学, 2021,32(12):1552-1556.
[10] 周军, 王勇, 马润星. 超声引导下腹横肌筋膜阻滞麻醉对老年腹腔镜手术患者疼痛应激及胃肠功能的影响[J].中国老年学杂志, 2020,40(17):3686-3689.
[11] 郭泽, 郑宏伟, 李姗姗, 等. 经皮椎板间入路与经皮椎间孔入路内镜下椎管减压术对老年重度腰椎管狭窄患者疼痛程度和腰椎功能的影响[J].中国临床医生杂志, 2023,51(3):337-339.
[12] 刘明军. 显微镜下神经减压治疗腰椎管狭窄症的疗效观察[J].颈腰痛杂志, 2023,44(1):133-134.
[13] 孙永欣, 张志彬, 安文涛, 等. 活血通督汤联合按摩对退行性腰椎管狭窄症患者相关血清炎症介质的影响[J].世界中医药, 2022,17(22):3206-3209. |
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2025, Vol. 42 
