Background:The combination of oblique lumbar interbody fusion (OLIF) and spinal endoscopy presents a promising minimally invasive approach for treating degenerative lumbar diseases, leveraging the strengths of both techniques to optimize clinical outcomes. We term this combined technique Endo-OLIF (endoscopy-assisted oblique lumbar interbody fusion). Objective:This study aimed to evaluate the early clinical efficacy and technical nuances of Endo-OLIF in the management of degenerative lumbar conditions. Methods:A retrospective analysis was conducted on 29 patients who underwent Endo-OLIF for degenerative lumbar diseases at our institution between February 2022 and November 2023. Inclusion criteria specified treatment of no more than two contiguous levels between L2 and L5. Patients with left-sided disc herniation or predominant left-sided stenosis were excluded due to technical considerations of the endoscopic working trajectory. Clinical outcomes were assessed using the visual analogue scale (VAS) for pain and the Oswestry Disability Index (ODI) for functional disability. The mean follow-up duration was 15.6 months (range 12-22 months). Results:All procedures were successfully completed without intraoperative complications such as nerve root injury or dural sac injury. Postoperatively, two patients (6.9%) experienced transient ipsilateral thigh numbness or hip flexion weakness, which we attribute to intraoperative retraction and blunt stimulation of the lumbar plexus; both resolved completely within 6 weeks without specific intervention. Postoperative imaging confirmed satisfactory interbody fusion and complete removal of herniated disc material. Significant improvements in VAS and ODI scores were observed at 3 months postoperatively and maintained at final follow-up (mean 15.6 months) (P < 0.05 for all comparisons). The mean VAS scores for back pain improved from 7.1 ± 1.3 preoperatively to 1.6 ± 0.7 at final follow-up; leg pain VAS improved from 6.3 ± 1.2 to 1.3 ± 0.5; ODI improved from 66.8 ± 9.7 to 12.6 ± 7.1. Patients reported high satisfaction levels, short recovery times, and no serious postoperative complications. Conclusion:Endo-OLIF capitalizes on the advantages of both minimally invasive approaches: OLIF preserves the posterior ligamentous complex and avoids nerve root irritation, while spinal endoscopy allows direct decompression by removing herniated disc material. This combined approach demonstrates favorable short-term outcomes with significant improvements in pain and functional disability scores. However, long-term efficacy requires further follow-up studies.

This study aimed to compare hidden blood loss (HBL) in patients undergoing arthroscopic rotator cuff repair based on the degree of rotator cuff fatty infiltration, and to determine whether fatty infiltration is associated with increased HBL and other risk factors. A retrospective analysis included 141 patients undergoing arthroscopic rotator cuff repair between January 2023 and March 2025. Patients were grouped by rotator cuff fatty infiltration severity (Grades 0–4). Demographics and blood parameters were recorded. Visible blood loss was quantified, and hidden blood loss (HBL) was calculated using preoperative hematocrit (Hctpre) and postoperative hematocrit (Hctpost) to assess total blood loss. Relationships with HBL were analyzed using Pearson/Spearman correlation, Mann-Whitney U test, and multivariate linear regression to identify independent risk factors. Multivariate linear regression analysis identified the following independent risk factors for HBL: Hctpost (β = -482.318. 95

Objective:The aim of this study was to describe the surgical technique of endoscopy-assisted anterior cervical discectomy and fusion (ACDF), to evaluate the advantages, efficacy, and safety of this procedure for the treatment of cervical spondylotic myelopathy (CSM). Methods:The clinical data of patients with CSM treated with endoscopy-assisted ACDF from January 2023 to December 2023 were retrospectively reviewed. And 35 patients, including 13 females and 22 males, were included in this study. Endoscopic assisted ACDF surgery was described step by step in detail, and clinical and imageological assessment were performed before and after operation and follow-up. Results:All 35 patients underwent endoscopy-assisted ACDF surgery successfully, and were followed up for 12.9 ± 2.1 months (range 9∼18 months). The operation time was 74.4 ± 10.7 min (range 60∼100 min). Postoperative drainage volume was 14.1 ± 5.8 mL (range 5∼25 mL). No complications were observed. There were no complications, aggravation of neurological symptoms after operation, and the JOA score at the last follow-up was significantly improved compared with that before operation (15.7 ± 0.8 vs. 10.3 ± 1.9, P < 0.001). At the last follow-up, the C2-C7 Cobb angle was significantly higher than that before operation (P < 0.001), and Δ Cobb angle was 7.4 ± 2.5˚, and all patients achieved bony fusion. Conclusions:Endoscopy-assisted ACDF, which combined the uniaxial spinal endoscopy with traditional ACDF, achieved satisfactory short-term clinical efficacy and safety in the treatment of CSM.

The lipoma is a common benign tumor of the subcutaneous body, and it is commonly found on the surface of the skin. But, it can also involve any tissue or organ. Intraspinal lipomas are rare, which account for less than 1% of intraspinal tumors. Among these, intramedullary lipoma is an even rarer condition, compared to extramedullary subdural or epidural types. Intraspinal tumors were removed by the open surgery in common, due to its adequate intraoperative visualization and complete resection. But for intraspinal lipomas, it does not exhibit implantation metastasis, making minimally invasive spinal endoscopic surgery considered as an option. We performed a resection of a intramedullary lipoma, and the surgery was conducted under the guidance of spinal endoscopy. Compared with open surgery, minimally invasive spinal endoscopic surgery may be more advantageous in reducing soft tissue injury and bony structure destruction, allowing patients to achieve rapid recovery. The symptoms of numbness in the left limb and unsteady gait of the patient completely disappeared after the operation. It should be noted that continuous bleeding during the operation exacerbates the complexity of the surgery. When removing lipomas, patience and meticulousness are crucial for the operation.

Oblique lumbar interbody fusion (OLIF) is a minimally invasive technique for the treatment of degenerative diseases of the lumbar spine, and the left operative window is always used to avoid the inferior vena cava (IVC). However, in cases with anatomical variations—particularly vascular anomalies, which most significantly impact surgical approaches—the right retroperitoneal approach may serve as a preferable alternative. This case report describes a 59-year-old man with lumbar instability and a rare left-sided IVC who underwent OLIF via a right approach. Preoperative imaging of this patient showed an isolated left IVC. The procedure was performed through a right-sided surgical corridor bounded medially by the abdominal aorta(AA) and laterally by the right psoas major muscle. The approach was supplemented with lateral screw-rod instrumentation to maintain stability. The patient's neurological function improved significantly after surgery, and the surgical approach proved to be feasible while maintaining biomechanical stability while avoiding vascular risk. This case highlights the importance of vascular evaluation before OLIF. Especially for the rare left-sided IVC, OLIF via right approach can effectively improve safety.

Oblique lumbar interbody fusion (OLIF) has been widely used to treat lumbar spinal stenosis. However, patients with prolapsed nucleus pulposus are not suitable for this surgery. We introduce a hybrid surgical procedure combining OLIF and full-endoscopic spinal canal decompression to address this issue. During the OLIF procedure, after completing the discectomy, the endoscopic system is inserted into the intervertebral space to perform the latter half of the discectomy, remove the loose nucleus pulposus, and achieve direct decompression of the nerve root under visualization. After decompression, the free nerve root can be seen under the endoscopic view. With the assistance of endoscopy, the indications for OLIF surgery can be expanded, allowing for the treatment of cases with sciatica caused by the nucleus pulposus. Intraoperative X-ray fluoroscopy can determine the direction and location of decompression under the endoscopy. All patients experienced satisfactory relief from their lumbar and leg pain after the surgery with no complications. Full-endoscopic decompression combined with oblique lumbar interbody fusion is an effective, safe surgical technique for lumbar spinal stenosis with prolapsed nucleus pulposus.

Cervical spondylotic myelopathy (CSM) is a common cause of cervical spinal cord disease. Spinal endoscopy offers surgical advantages such as a magnified view and a water-mediated clear surgical field. This study describes an endoscope-assisted anterior cervical discectomy and fusion (ACDF) procedure. The addition of spinal endoscopy to traditional ACDF surgery magnifies the surgical field and allows for more precise operations, thereby improving surgical safety. Postoperatively, patients experienced significant improvements in neurological function, with no complications such as dysphagia, hematoma, or spinal cord injury. Postoperative imaging revealed that spinal cord compression was completely relieved, with sufficient decompression of the spinal cord and optimal placement of the fusion cage. The clear visual field provided by spinal endoscopy improves the identification of cervical anatomical structures during surgery, effectively reducing the risk of injury to the spinal cord and nerves. Endoscope-assisted ACDF has demonstrated excellent clinical and radiological outcomes in the treatment of CSM.

STUDY DESIGN:To analyze the biomechanical properties of stand-alone oblique lumbar interbody fusion (SA OLIF) cage using finite element analysis. OBJECTIVE:Established the L3-5 finite element model to study the SA OLIF from the stability and the stress of the cage. SUMMARY OF BACKGROUND DATA:SA OLIF is less invasive, but whether SA OLIF is stable and increases the risk of cage subsidence remains controversial. METHOD:The L3-5 CT image data of a healthy adult male volunteer was selected. First, calculate the range of motion (ROM) of L4-5 under flexion, extension, left bending, right bending, left rotation, and right rotation.Then, the L4-5 intervertebral discs were excised, and the cage was implanted to establish a SA OLIF model. On this basis, bilateral pedicle screw (BPS) fixation was added to establish the BPS model. Analyze the ROM of L4-5 and the maximum stress of cage under all motion patterns. RESULTS:The ROM of L4-5 segments in the validation model was basically consistent with previous reports. The range of activity of BPS in each working condition was significantly lower than that of Normal and SA. Compared with BPS, Normal and SA increase by 925.9%, 1034.6%, 1107.4%, , and 1146.2% in flexion and extension, respectively. SA had higher range of activity than normal in flexion and extension, but lower in left bending, right bending, left rotation, and right rotation. The maximum stress of SA cage was greater than that of BPS under all working conditions, and increased by 363.2% and 1899.4% in flexion and extension, respectively, compared with BPS. CONCLUSIONS:SA OLIF is relatively poor in maintaining the stability of the fusion segment, and there is a higher risk of cage subsidence in the later stage.

Background: To analyze the biomechanics of Stand-alone eXtreme lateral interbody fusion (Standalone XLIF) cage using finite element analysis. Method: The L3-5 CT image data of a healthy adult male volunteer was selected to establish a normal lumbar vertebrae finite element model. Fix the lower edge of the L5, apply 500N pressure on the upper edge of the L3, and apply a torque of 7.5Nm, calculate the range of motion (ROM) of L4-5 under flexion, extension, left bending, right bending, left rotation, and right rotation.Then, the L4-5 intervertebral discs were excised, and the cage was implanted to establish a Stand-alone XLIF model. On this basis, bilateral pedicle screw fixation (BPSF) was added to establish the BPSF model. Analyze the ROM of L4-5 and the maximum stress of cage under all motion patterns. Results: The ROM of L4-5 segments in the validation model under various motion states was basically consistent with previous reports. The lumbar finite element model was validated effectively. The range of activity of BPSF in each working condition was significantly lower than that of Normal and Stand-alone. Compared with BPSF, Normal and Stand-alone increase by 925.9%,1034.6% and 1107.4%,1146.2% in flexion and extension, respectively. Stand-alone had higher range of activity than Normal in flexion and extension, but lower in left bending, right bending, left rotation and right rotation. The maximum stress of stand-alone cage was greater than that of BPSF under all working conditions, and increased by 363.2% and 1899.4% in flexion and extension respectively compared with BPSF. Conclusions: Stand-alone XLIF is poor in maintaining the stability of the fusion segment, and there is a higher risk of cage subsidence in the later stage.

Ossification of the ligamentum flavum (OLF) can result in spinal stenosis. Thoracic spinal cord compression due to spinal stenosis is a common cause of progressive thoracic myelopathy in Asian countries. The incidence of complications is high in open decompression surgeries for thoracic OLF. With dural ossification (DO), the risk of complications is even higher in thoracic OLF. We introduce a full-endoscopic decompression surgery for thoracic OLF combined with DO under local anesthesia. Hemilaminectomy is performed using a high-speed burr under the endoscopy first, and then decompression of the contralateral spinal canal is completed using an "over the top" technique. DO resection uses the eggshell technique; after the base of the DO is cut from the lamina, forceps or lamina rongeurs are typically used for removal. The dural defect left after resection does not need repair. Neurological function was improved, and no complications such as hematoma or neck pain occurred. On imaging, no pseudodural cyst, cerebrospinal fluid leakage, or wound complications were observed after the operation. Endoscopic surgery causes less damage to the posterior ligament complex, so no cases of persistent back pain complaints or secondary internal fixation requirements were found in this study. Full-endoscopic decompression can achieve good imaging and clinical effects in the treatment of thoracic OLF with DO.

目的 本研究旨在评价防旋股骨近端髓内钉(proximal femoral nail antirotation,PFNA)治疗高龄严重骨质疏松不稳定型股骨转子间骨折的安全性和有效性.方法 回顾性分析2019年1月至2020年12月河北省人民医院行PFNA治疗的高龄重度骨质疏松不稳定型股骨转子间骨折患者84例,其中男33例,女51例;年龄61～96岁,平均(77.42±6.86)岁.结果 随访时间8～13个月,平均(11.20±3.45)个月.平均手术时间(72.36±8.91)min,术中出血量(72.80±9.18)mL,术中透视次数(25.32±8.45)次.患者术后至助行器辅助下下床活动时间(8.71±4.01)d,负重锻炼时间(12.42±3.31)周,骨折愈合时间(14.33±4.36)周.术后6个月Harris评分(89.15±5.50)分.术后并发症发生率7.14％,其中内固定失效1例,骨折延迟愈合2例,围手术期外侧壁骨折3例,无骨不连发生.结论 PFNA是治疗高龄严重骨质疏松不稳定型股骨转子间安全有效的治疗选择.

Context:With the rapidly aging population globally, osteoporosis (OP) has become a major public health problem, and fracture is a common complication of OP. Older adults, especially postmenopausal women, have a higher incidence of OP.Objective:The study intended to analyze the clinical information, epidemiological characteristics, treatments, and follow-up results of patients with osteoporotic fractures (OPFs) in adults over 65 years old, to provide data support for the prevention, treatment, and use of OPF focus groups in clinical practice.Design:The research team performed a retrospective analysis using electronic medical records and related imaging data of patients.Setting:The study took place at Hebei General Hospital in Hebei, China.Participants:Participants were 387 patients over 65 years old with osteoporotic fractures who had been admitted to the hospital between July 2012 and July 2018.Outcome Measures:The research team recorded participants' ages, genders, fracture causes, and fracture sites. The team performed a follow-up analysis on refractures, treatment with anti-osteoporotic drugs, exercise, and survival status within the 3 years after surgery.Results:The study's male-to-female ratio was 1:3.1, and the rate of osteoporotic fracture for females was significantly higher than that of males. The mean age of participants with fractures was 75.6 ± 8.5 years, and most fractures occurred in participants 78 to 85 years old. Of the 387 participants, 169 participants had hip fractures (43.67%); 98 had vertebral compression fractures (25.32%); 51 had distal radius and ulna fractures (13.18%); 42 had proximal humerus fractures (10.85%); and 27 had other fractures (6.98%). The number of women with fractures at each site was greater than the number of men, but the differences weren't statistically significant (P > .05). The main causes of injury were falls (71.58%), and the main place of the occurrence of injury was at home (65.6%). Of the 387 participants, 346 had surgical treatment (89.41%), and the effective rate of surgical treatment was 99.42%. Three years after surgery, the research team followed up with 235 participants, for a follow-up rate of 60.72%. Within the 3 years of the follow-up period, 61 participants had refractures (25.63%), 29 received treatment with regular anti-osteoporotic drugs (12.34%), 36 exercised twice or more a week (15.32%), and 32 had died for various reasons (13.62%).Conclusions:The study preliminarily described the epidemiological characteristics of 387 osteoporotic fractures in adults over 65 years old. More women had fractures than men; the hip was the most common fracture site, and falls were the main cause of injury. Most of the fractures occurred in the place of residence, and the refracture rate was 25.96% at three years after surgery.

目的 探讨后路经皮脊柱内镜下椎间盘髓核摘除术治疗神经根型颈椎病的临床疗效.方法 采用后路经皮脊柱内镜下椎间盘髓核摘除术治疗41 例神经根型颈椎病患者.记录疼痛VAS评分、NDI及并发症发生情况,采用改良MacNab标准评价临床疗效.结果 患者均获得随访,时间 12～25 个月.切口均一期愈合,未出现感染、硬膜囊撕裂、颈脊髓损伤及颈椎不稳等严重并发症,无翻修手术者.疼痛VAS评分及NDI:术后1d及1、6、12 个月均较术前降低(P<0.05).术后1 年采用改良MacNab标准进行疗效评价:优14 例,良24例,可3 例,优良率92.7%(38/41).结论 后路经皮脊柱内镜下椎间盘髓核摘除术可有效改善神经根型颈椎病症状,是一种安全、有效的微创手术方式,早期疗效可靠.

目的 研究股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)、联合加压交锁髓内钉系统(TriGen InterTAN hip fracture nailing system,InterTAN)、股骨近段锁定钢板(proximal femoral locking compression plate,PF-LCP)在治疗老年股骨粗隆间骨折中的临床效果.方法 采用回顾性研究的方式,收集2019年1月至2020年8月收治的老年粗隆间骨折患者146例,男67例,女79例;年龄62～84岁,平均(76.42±8.86)岁.按照手术方式不同,分为PFNA组50例、InterTAN组48例和PF-LCP组48例.比较3组患者手术时间、术中出血量、术中透视次数、下床活动时间、负重锻炼时间、骨折愈合时间、术后6个月Harris评分及并发症发生情况等.结果 146例患者术后获随访8～16个月.在手术时间、术中出血量方面,PFNA组优于InterTAN组,InterTAN组优于PF-LCP组,差异均有统计学意义(P<0.05);PF-LCP组在术中透视次数少于PFNA组和InterTAN组,差异有统计学意义(P<0.05);下床活动时间、负重锻炼时间和骨折愈合时间方面,InterTAN组优于PFNA组,PFNA组优于PF-LCP,差异有统计学意义(P<0.05);术后6个月Harris评分方面,PFNA组与InterTAN组之间无明显统计学差异(P>0.05),但2组均优于均PF-LCP组,差异均有统计学意义(P<0.05);在术后并发症方面,InterTAN组优于PFNA组,PFNA组优于PF-LCP,差异有统计学意义(P<0.05).结论 对于老年粗隆间骨折,PFNA和InterTAN的治疗效果要优于股骨近端锁定钢板,可以提高骨折复位质量,有效降低术后并发症,促进骨折愈合和髋关节功能恢复.PFNA操作简单,手术时间短,出血量更少,适合不能耐受长时间手术的患者,而InterTAN具有更好的抗旋稳定性,内固定失效的发生率更低,这两种内固定方式各有优势,需要根据患者自身情况,进行合理选择.

Purpose:The purpose of this study is to investigate the clinical effect of posterior lumbar fusion surgery on patients who suffer from lumbar disc herniation concurrent with peroneal nerve paralysis.Methods:The patients suffering from peroneal nerve paralysis and undergoing posterior lumbar fusion surgery between January 2012 and December 2019 were retrospectively reviewed. The data of the identified patients were then collected and processed. All patients were followed up post-operatively after discharge from the hospital. The data was analyzed in terms of Oswestry disability index (ODI), visual analogue scale (VAS) score, and relative lower-limb muscle strength.Results:A total of 87 patients (52 males and 35 females) aged 54 ± 11 years met the inclusion criteria for this study. These patients stayed in hospital for 16 ± 6 days and were followed up for 81 ± 24 months. Data analysis showed that muscle strength of the tibialis anterior and extensor digitorum significantly recovered at the last follow-up with a grade of 3 (median), compared to grade 0 at admission (p < 0.001). Furthermore, the median VAS score decreased to 1 at the last follow-up from 6 at admission (p < 0.001), and the ODI greatly improved with 10% (median) at the last follow-up, while it was 58% at admission (p < 0.001). The ODI improvement rate was 60% on average at the last follow-up. Multivariate regression analysis regarding the ODI and muscle strength improvement rates showed that advanced age was a risk factor for postoperative recovery.Conclusions:Most of the patients suffering from lumbar disc herniation concurrent with peroneal nerve paralysis can improve after undergoing posterior lumbar fusion surgery, but few can reach full recovery. Advanced age might be a risk factor that affects the prognosis of these patients after surgery.

患者,男,86岁,1年前发现右臀部肿物,彩超提示:右侧臀部软组织内可见低回声团块,大小约115.4 mm×61.5 mm x49.5 mm,边界尚清,内回声欠均,彩色多普勒及能量图可见短棒状血流信号.近半个月来患者自觉肿物增大,平卧时感压痛不适,于2020年8月至河北省人民医院就诊.入院查体:右侧臀部可见约8 cm×12 cm大小类圆形肿物,皮色正常,皮温稍高,轻度压痛,表面不光滑,边界清楚,活动度可.

目的 研究防旋型股骨近端髓内钉(proximal femoral nail antirotation,PFNA)联合锁定钢板治疗合并外侧壁骨折的老年粗隆间骨折的临床效果.方法 采用回顾性研究方式,收集2019年1月—2020年12月期间河北省人民医院骨科收治的48例合并股骨外侧壁骨折的老年粗隆间骨折患者的临床资料,男性21例,女性27例;年龄65～98岁,平均79.6岁.按照当时所采取的手术方式不同,将患者分为试验组(n=24)和对照组(n=24).试验组采用PFNA联合使用锁定钢板对外侧壁进行重建,对照组仅使用PFNA进行粗隆间骨折的固定,未重建外侧壁.比较两组手术时间、透视次数、术中出血量、下床活动时间、负重锻炼时间、骨折愈合时间、末次随访髋关节功能(Harris评分)及并发症发生等.结果 48例患者均获得随访,时间9～18个月,平均12.6个月.与对照组相比,试验组手术时间[(81.25±6.90)min vs.(72.21±6.72)min]、术中出血量[(97.54±6.99)mL vs.(70.63±9.87)mL]、术中透视次数[(49.67±6.23)次vs.(38.33±8.32)次]均有所增加(P<0.05);试验组在下床活动时间[(8.83±3.13)d vs.(11.50±1.72)d]、骨折愈合时间[(13.71±3.98)周vs.(16.29±3.67)周]、负重锻炼时间[(11.42±3.35)周vs.(14.33±2.76)周]和末次随访Harris评分[(88.46±4.23)分vs.(81.21±6.31)分]方面均具有明显优势(P<0.05);在术后并发症方面,试验组发生率为12.5％,明显低于对照组的37.5％(P<0.05).结论 对于合并外侧壁骨折的老年粗隆间骨折,重建外侧壁可以获得更好的治疗效果,可以提高骨折复位质量,有效减少术后并发症,促进骨折愈合和髋关节功能的恢复.

目的 总结全内镜下胸椎管减压术治疗胸椎管狭窄症的技术要点,分析全内镜下胸椎管减压术的临床疗效.方法 回顾性分析本院2017年6月至2020年12月收治的27例应用全内镜下椎管减压术治疗的单节段胸椎管狭窄症患者,致压因素为胸椎黄韧带骨化(ossification of ligamentum flavum,OLF)14例,胸椎间盘突出伴纤维环骨化2例,后纵韧带骨化或椎体后缘骨赘9例,胸椎OLF合并后纵韧带骨化2例.根据致压因素位于脊髓腹侧或背侧压迫的严重程度,采取经椎板间入路或者经椎间孔入路.通过评价术前、术后和随访过程中的影像学表现评估手术减压情况.记录手术时间、手术并发症.应用改良日本骨科协会评分(modified Japanese Orthopedic Association,mJOA,11分法)评估术前和术后的神经功能并计算其改善率.结果 所有手术顺利完成,采用经椎板间入路脊髓背侧减压术14例,经椎间孔入路脊髓腹侧减压术11例,经椎间孔入路脊髓腹侧背侧同时减压2例.手术时间为159.1 min,其中经椎板间入路脊髓背侧减压手术时间为160 min,经椎间孔入路脊髓腹侧减压手术时间为136 min.所有患者术后及随访过程中的CT及MRI影像显示脊髓减压充分.术前mJOA评分1～10分,平均(6.0±2.3)分.末次随访时mJOA评分5～11分,平均(8.7±2.0)分,术前与术后差异有统计学意义(P<0.001),mJOA评分改善率25％～100％,平均64.5％.术中并发颈项疼痛2例,术中一过性神经功能恶化1例.术中硬膜缺损5例,其中4例为胸椎OLF合并硬膜骨化,未行硬膜修补,术后未出现影像学或有临床表现的假性硬膜囊肿或切口不愈合.术后48 h出现迟发性硬膜外血肿1例,二次内镜下探查血肿清除术后症状改善.结论 全内镜下胸椎管减压术治疗胸椎管狭窄症是一项安全有效的技术,做到脊髓充分减压的同时可以更好地减小手术创伤,规避并发症.

目的 比较改良俯卧位下椎间孔入路与椎板间入路脊柱内镜手术治疗合并高髂嵴的L5-S1椎间盘突出症的疗效.方法 选取2016年8月～2018年12月本院收治的35例合并高髂嵴的L5-S1腰椎间盘突出症患者为研究对象,根据手术方式分为研究组15例和对照组20例.研究组接受改良俯卧位下椎间孔入路脊柱内镜手术,对照组接受椎板间入路脊柱内镜手术.比较两组患者手术时间、及术后住院时间等指标,观察术前及术后随访各时间点的疗效指标和并发症发生情况.结果 研究组手术时间、及术后住院时间与对照组差异均无统计学意义(P>0.05),但术中透视次数明显多于对照组(P<0.05).手术后1 d、1个月、3个月和12个月,两组患者VAS评分、ODI指数均较术前显著降低(P<0.05);但组间差异均无统计学意义(P>0.05).术后随访12个月,研究组术后优良率86.67％与对照组85.00％比较,差异无统计学意义(P>0.05).研究组术后并发症发生率低于对照组,但差异无统计学意义(0％vs15.00％,P>0.05).结论 改良俯卧位下椎间孔入路与椎板间入路脊柱内镜手术均可用于治疗合并高髂嵴的L5-S1椎间盘突出症,术后疗效相当,但前者术后并发症发生率相对较低.