| Objectives1.This topic through a prospective randomized study of percutaneous endoscopic decompression(PED)and posterior lumbar interbody fusion(PLIF)for the treatment of single segment lumbar spinal stenosis.Through the analysis of two groups of patients before and after surgery seventh days、third months、sixth months visual analogue scale(VAS score),the Japanese Orthopaedic Associationscores(JOA score),Oswestry disability index(ODI score),operative time,blood loss,hospital stay and complications during follow-up,to evaluate the efficacy and safety of PED and PLIF in the treatment of lumbar spinal stenosis.2.To analyze the correlation between the changes of image data and the improvement of clinical symptoms before and after the operation,so that It provides the theoretical basis for defining the responsibility section and reducing the pressure of operation.Methods1.Collection of Guangdong Province Traditional Chinese Medical Hospital inpatient from January 2015 to October 2016 due to single segment LSS patients with PED or PLIF surgery.2.According to the order of the patients entering the trial,the patients were randomly assigned to PED group and PLIF group with 30 cases in each group.3.The age,gender,course of disease,as well as preoperative VAS score,JOA score and ODI score were investigated and analyzed to determine the baseline factors of the two groups were not statistically significant,and the patients in the two groups were comparable.4.By the same batch of deputy director of the doctor to complete the operation,in order to reduce the error caused by surgical techniques.Two groups of patients before and after surgery seventh days、third months、sixth months VAS score,JOA score,ODI score,operative time,blood loss,complications and hospitalization days follow-up were recorded and statistics.Patients in group PED underwent CT and MRI examinations before and after surgery seventh days、third months、sixth months.The narrowest vertebral canal area,the narrowest intervertebral foramen area in the side of symptomsand and the narrowest sagittal diameter of lateral lateral recess in the side of symptomsand were measured at four time points.The differences of VAS,JOA,ODI,operation time,blood loss and length of hospital stay were compared between the two groups before and after the operation,and the relationship between clinical improvement and imaging variables in the PED group before and after the operation.Results1.Two groups of patients were followed up,including 30 cases of PED group,L5/S1 segment stenosis in 13 cases,posterior laminectomy approach in 9 cases,lateral transforaminal approach in 4 cases,L4/5 segment stenosis in 15 cases,posterior approach in 4 cases,lateral transforaminal approach in 11 cases,L3/4 segmental stenosis in 2 cases,underwent lateral transforaminal.The age,gender,course of disease,as well as preoperative VAS score,JOA score and ODI score were investigated and analyzed to determine the baseline factors of the two groups were not statistically significant,and the patients in the two groups were comparable.2.Two groups of patients after surgery seventh days、third months、sixth months lower limb VAS score and preoperative comparison,the difference was statistically significant(P<0.05).There was no significant difference between the two groups in the three time points(P>0.05).The two kinds of operation methods could effectively decompress the nerve roots and effectively alleviate the symptoms of lower limb radiation pain in patients with single stage LSS.Two groups of patients at three time points of lumbar JOA score compared with preoperative,the difference was statistically significant(P<0.05),the two groups between the three time points were not statistically significant(P>0.05).Two groups of patients at three time points after the ODI score and preoperative comparison,the difference was statistically significant(P<0.05),between the two groups at three time points,the difference was not statistically significant(P<0.05)。Two kinds of operation mode can improve the patients’ JOA score and ODI score,two patients were followed up for process and there was no surgery related complications,can be seen two operation methods significantly improve the clinical symptoms of the patients with LSS single segment,improve the quality of life,the operation is safe,feasible and effective.3.PED group and PLIF group the seventh days、third months、sixth months after the operation of the lumbar JOA score compared with the same group before surgery,the difference was statistically significant(P<0.05),PED group and PLIF group of lumbar JOA score in postoperative follow-up of seventh days、third months、sixth months were(20.17± 1.39)and(20.90 ±1.67),(25.10±1.42)and(24.53±1.01),(27.57±0.68)and(27.70 ±0.65),no significant difference significance(P0.05);PED group and PLIF group the seventh days、third months、sixth months after the operation of the ODI score compared with the same group before surgery,the difference was statistically significant(P<0.05).The ODI scores of the two groups in postoperative follow-up of seventh days、third months、sixth months were(34.10±1.77)and(34.77±1.74),(25.23±1.46)and(24.80±1.27),(22.27±1.11)and(22.47±1.47),there was no statistically significant difference(P>0.05).The two groups during the follow-up process did not occur with surgery related complications,can be seen two operation methods significantly improve the clinical symptoms and the quality of LSS patients life,the operation is safe,feasible and effective;4.There was no significant correlation between the imaging parameters and the age,sex and course of the disease(P>0.05).The narrowest vertebral canal area,the narrowest intervertebral foramen area in the side of symptomsand and the narrowest sagittal diameter of lateral lateral recess in the side of symptomsand and the preoperative comparison between three points were statistically significant(P<0.05).The improvement of clinical symptoms was related to The narrowest vertebral canal area,the narrowest intervertebral foramen area in the side of symptomsand and the narrowest sagittal diameter of lateral lateral recess in the side of symptomsand(P<0.05).Conclusion1.For the implementation of percutaneous endoscopic decompression for the treatment of single segment lumbar spinal stenosis should be a detailed analysis of preoperative imaging data,lesion site,combined with the symptoms and signs of surgical planning,intraoperative decompression to the full target can effectively improve the clinical curative effect,to achieve the purpose of the operation.2.Percutaneous endoscopic decompression with posterior lumbar interbody fusion for the treatment of the clinical curative effect of single segmental lumbar spinal stenosis short exact,strictly grasp the indications for surgery,can achieve percutaneous endoscopic decompression in the treatment of single segment lumbar spinal stenosis with the advantages of small trauma,safe and quick recovery. |
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