基于加速康复外科理念的单孔分体内镜微创技术治疗腰椎管狭窄症的临床效果分析

doi:10.6040/j.issn.1671-7554.0.2024.1169

摘要/Abstract

摘要： 目的探讨加速康复外科(enhanced recovery after surgery, ERAS)理念下的单孔分体内镜(one-hole split endoscope, OSE)治疗方案治疗腰椎管狭窄症(lumbar spinal stenosis, LSS)的临床疗效。方法回顾性分析2020年1月至2023年12月在山东大学齐鲁医院接受治疗的腰椎管狭窄症患者130例,其中男71例,女59例,23~77岁,平均(54.42±11.82)岁,依据患者既往诊疗过程中是否遵循ERAS理念将其分为两组:采用ERAS理念下的OSE治疗方案的患者为ERAS方案组(n=65);未采用ERAS理念下的传统椎板间开窗手术治疗方案的患者归入非ERAS方案组(n=65)。比较两组患者住院时间、手术时间、估计失血量、并发症发生率、腰腿痛视觉模拟评分(visual analog scale, VAS)、Oswestry功能障碍指数(oswestry disability index, ODI)、日本骨科协会评估治疗评分(Japanese Orthopaedic Association scores, JOA),改良MacNab疗效评价标准。结果 ERAS方案组术后第2天VAS、ODI和JOA评分明显优于非ERAS方案组(P<0.05);术后3个月,两组间VAS、ODI、JOA评分和改良MacNab疗效评价标准无明显差异(P>0.05)。ERAS方案组平均手术时间较非ERAS方案组长,平均估计失血量和平均住院时间则显著少于非ERAS方案组(P<0.05)。随访时间截止前,两方案组均无患者再次入院。非ERAS方案组有3例出现术后并发症,而ERAS方案组仅1例出现术后并发症。结论将单孔分体内镜手术与ERAS理念结合治疗腰椎管狭窄症,有助于促进术后快速康复。ERAS理念下的内镜手术治疗方案或可视为治疗腰椎管狭窄症的有效替代策略。

关键词: 加速康复外科, 单孔分体内镜, 腰椎管狭窄症, 微创技术

Abstract: Objective To investigate the clinical efficacy of the one-hole split endoscope(OSE)treatment protocol under the enhanced recovery after surgery(ERAS)concept for treating lumbar spinal stenosis(LSS). Methods A retrospective analysis was conducted on 130 LSS patients treated at Qilu Hospital of Shandong University between January 2020 and December 2023. There were 71 males and 59 females, aged 23 to 77 years, with a mean age of(54.42±11.82)years. Patients were divided into the following two groups based on whether the ERAS concept was followed during their treatment. The ERAS group(n=65)received the OSE treatment under the ERAS concept, while the non-ERAS group(n=65)underwent the traditional interlaminar fenestration surgery without the ERAS concept. Key outcomes, including hospitalization duration, operation time, estimated blood loss, complication incidence, visual analog scale(VAS)for low back and leg pain, Oswestry disability index(ODI), Japanese Orthopaedic Association scores(JOA), and modified MacNab efficacy evaluation criteria(MacNab), were compared between the two groups. Results The ERAS group showed significantly better VAS, ODI, and JOA scores than the non-ERAS group at two days after the operation(P<0.05). However, at 3 months after the operation, there were no significant differences between the two groups in VAS, ODI, JOA scores, and modified MacNab criteria(P>0.05). The average operation time in the ERAS group was longer than in that the non-ERAS group, whereas the average estimated blood loss and hospitalization duration were significantly shorter than those in the non-ERAS group(P<0.05). No patients in either group required readmission before the end of the follow-up period. Additionally, postoperative complications were observed in three patients in the non-ERAS group, compared to only one patient in the ERAS group. Conclusion The combination of OSE surgery and ERAS concept in LSS treatment promotes rapid postoperative recovery. Consequently, the endoscopic surgical treatment under the ERAS concept could be considered an effective alternative strategy for LSS treatment.

Key words: Enhanced recovery after surgery, One-hole split endoscope, Lumbar spinal stenosis, Minimally invasive technique

中图分类号:

R681.5

胡冰涛,张文灿,王崇怡,林翔宇,王凯斌,冯运泽,刘郴,徐万龙,李乐,司海朋. 基于加速康复外科理念的单孔分体内镜微创技术治疗腰椎管狭窄症的临床效果分析[J]. 山东大学学报 (医学版), 2025, 63(3): 1-7.

HU Bingtao, ZHANG Wencan, WANG Chongyi, LIN Xiangyu, WANG Kaibin, FENG Yunze, LIU Chen, XU Wanlong, LI Le, SI Haipeng. Clinical analysis of one-hole split endoscope for lumbar spinal stenosis based on enhanced recovery after surgery[J]. Journal of Shandong University (Health Sciences), 2025, 63(3): 1-7.

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