经Kambin三角与后方椎板间隙入路脊柱内镜术对腰椎间盘突出伴侧隐窝狭窄患者的影响

doi:10.3969/j.issn.1006-5725.2025.20.014

摘要/Abstract

摘要：

目的分析经Kambin三角入路与经后方椎板间隙入路脊柱内镜手术对腰椎间盘突出症（LDH）伴侧隐窝狭窄患者的影响。方法选取152例LDH伴侧隐窝狭窄患者，按照手术入路方式分为Kambin组（n = 77）与椎板间隙组（n = 75），两组分别经Kambin三角入路、经后方椎板间隙入路。对比两组手术相关指标、视觉模拟评分法（VAS）、Oswestry功能障碍指数（ODI）评分、侧隐窝狭窄面积、并发症发生率。结果 Kambin组手术时间及术后住院时间均短于椎板间隙组（P < 0.05）；Kambin组术后1 d、1个月的VAS评分均低于椎板间隙组（P < 0.05）；两组术后1、3个月的ODI评分比较无明显差异（P > 0.05）；两组术后侧隐窝狭窄面积比较无明显差异（P > 0.05）。椎板间隙组出现1例术后感染。结论 Kambin入路手术时间更短，两种入路均有效改善功能、扩大侧隐窝，椎板间隙入路需优化减少并发症。

关键词: 腰椎间盘突出症, 侧隐窝狭窄, 经Kambin三角入路, 经后方椎板间隙入路, 腰椎功能

Abstract:

Objective To evaluate and compare the effects of endoscopic spinal surgery performed via the Kambin's triangle approach and the posterior interlaminar approach on patients diagnosed with lumbar disc herniation （LDH） and concurrent lateral recess stenosis. Methods The clinical data of patients who underwent lumbar pedicle screw fixation at our hospital between January 2017 and December 2023 were retrospectively analyzed. Patient information including sex， age， diagnosis， surgical level， presence and type of postoperative neurological complications was recorded. Based on postoperative CT scans， the zone and grade of screw penetration were assessed， and the distribution of different types of pedicle screw penetration was documented. The association between specific types of pedicle screw penetration and the occurrence of postoperative neurological symptoms was then analyzed. Results The operation time and postoperative hospital stay in the Kambin group were significantly shorter than those in the interlaminar group （P < 0.05）. On postoperative day 1 and at 1 month postoperatively， the VAS scores in the Kambin group were significantly lower than those in the interlaminar group （P < 0.05）. No significant differences were observed between the two groups in terms of ODI scores on postoperative day 1 and at 3 months postoperatively， or in the postoperative area of lateral recess stenosis （P > 0.05）. One case of postoperative infection was reported in the interlaminar group. Conclusions For patients with LDH and lateral recess stenosis， endoscopic spinal surgery via the Kambin's triangle approach is associated with a shorter operative duration. Both the Kambin's triangle approach and the interlaminar approach can effectively improve functional outcomes and decompress the lateral recess. However， the interlaminar approach requires further optimization to minimize the risk of complications.

Key words: lumbar disc herniation, lateral recess stenosis, kambin's triangle approach, posterior interlaminar approach, lumbar function

中图分类号:

R681.53

严纪元,李越,肖清清. 经Kambin三角与后方椎板间隙入路脊柱内镜术对腰椎间盘突出伴侧隐窝狭窄患者的影响[J]. 实用医学杂志, 2025, 41(20): 3243-3248.

Jiyuan YAN,Yue LI,Qingqing.. XIAO. Effects of endoscopic spine surgery via Kambin's triangle approach and posterior interlaminar approach on patients with lumbar disc herniation and lateral recess stenosis[J]. The Journal of Practical Medicine, 2025, 41(20): 3243-3248.

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组别	例数	性别/例		年龄/岁	病程/月	手术部位/例		体质量指数/（kg/m²）	术中透视次数/次	侧隐窝狭窄程度/例
组别	例数	男	女	年龄/岁	病程/月	L4/5	L5/S1	体质量指数/（kg/m²）	术中透视次数/次	轻度	中度	重度
Kambin组	77	47	30	47.58 ± 5.63	35.69 ± 4.12	48	29	23.14 ± 1.69	2.36 ± 0.42	21	43	13
椎板间隙组	75	42	33	47.39 ± 5.91	34.96 ± 4.65	45	30	23.27 ± 1.57	2.48 ± 0.35	18	47	20
χ²/t值		0.398		0.203	1.025	0.087		0.491	1.911	1.152
P值		0.528		0.839	0.307	0.767		0.624	0.058	0.562

组别	例数	手术时间/min	术中出血量/mL	术后住院时间/d
Kambin组	77	65.89 ± 7.12	30.11 ± 3.46	5.68 ± 0.68
椎板间隙组	75	75.14 ± 8.22	31.05 ± 3.25	6.21 ± 0.76
t值		7.422	1.725	4.533
P值		< 0.001	0.087	< 0.001

组别	例数	VAS评分
组别	例数	术前	术后1 d	术后1个月
Kambin组	77	6.52 ± 1.16	1.87 ± 0.26^#	1.10 ± 0.22^#
椎板间隙组	75	6.42 ± 1.31	2.25 ± 0.36^#	1.45 ± 0.31^#
t值		0.499	7.475	8.044
P值		0.619	< 0.001	< 0.001

组别	例数	ODI评分
组别	例数	术前	术后1个月	术后3个月
Kambin组	77	58.63 ± 6.35	37.14 ± 4.25^#	27.02 ± 3.12^#
椎板间隙组	75	57.98 ± 6.45	38.48 ± 4.16^#	27.69 ± 3.15^#
t值		0.626	1.964	1.338
P值		0.532	0.051	0.183

组别	例数	侧隐窝狭窄面积
组别	例数	术前	术后
Kambin组	77	32.54 ± 4.12	6.82 ± 0.76^#
椎板间隙组	75	31.99 ± 4.59	6.71 ± 0.85^#
t值		0.778	0.842
P值		0.438	0.401