显微内窥镜下单侧入路双侧减压治疗腰椎椎管狭窄症  

Microendoscopic treatment of lumbar spinal stenosis by unilateral approach for bilateral decompression

作　　者：吴一民[1] 银和平[1] 白明[1] 李树文[1] 刘聪[1] 曹振华[1] 

机构地区：[1]内蒙古医学院第二附属医院微创脊柱外科,呼和浩特010030

出　　处：《中华骨科杂志》2008年第12期1024-1027,共4页Chinese Journal of Orthopaedics

摘　　要：目的探讨显微内窥镜下利用单侧入路双侧减压技术治疗腰椎椎管狭窄症的手术适应证及临床疗效。方法2005年2月至2007年6月，采用显微内窥镜下单侧人路双侧减压技术治疗腰椎椎管狭窄症患者53例，男36例，女17例；年龄52～75岁，平均57岁。全部病例均有腰痛、单侧或双侧下肢疼痛、麻木及神经性间歇性跛行病史，其中有双下肢症状者均自觉一侧下肢症状较重。所有患者术前均行腰椎X线摄片、CT、MR等影像学检查确诊为单节段腰椎椎管狭窄症，并结合临床表现排除退变性腰椎失稳、多节段腰椎椎管狭窄。术后患者获得平均16个月（8-26个月）的随访，采用视觉模拟评分法（visual analogue scale，VAS）及腰椎功能障碍指数（Oswestry disability index，ODI）评定患者手术后的疗效。结果术后无硬脊膜撕裂、神经根损伤等严重并发症发生。VAS及ODI评定结果显示患者手术前后的VAS及ODI分值改变有统计学意义（P〈0．01）。术后CT显示椎管得到有效扩大，解剖结构破坏较少。结论显微内窥镜下单侧入路双侧减压技术减压效果良好，复发率低，适用于早期症状较轻的单节段腰椎椎管狭窄症患者。Objective To evaluate the feasibility and clinical efficacy of mieroendoscopic unilateral approach for bilateral decompression in patients with lumbar spinal stenosis. Methods From February 2005 to June 2007, minimally invasive microendoscopic decompressive laminotomy was performed in 53 patients with classic features of lumbar stenosis. By use of a fluoroscopically guided percutaneous technique, the operation was performed by a muscle-splitting approach using a series of tubular dilators with consecutively increasing diameters. A tubular retractor as working portal was then inserted on the lamina with minimal soft-tissue injury, and a specially designed endoscope was placed inside the tubular retractor. The microlaminotomy was performed endoscopically while the surgeon viewed the procedure on a video monitor. With the angle of the endoscope combined with an oblique entry, a bilateral bony and ligamentous decompression was achieved under the midline, thereby preserving the supraspinous-interspinous ligaments and contralateral musculature. Postoperative clinical outcomes, including visual analog scale （VAS） scores and Oswestry Disability Index （ODI） scores were assessed preoperatively, at 3rd week, and 12th week after surgery. The mean follow-up was 16months （range 8-26months）. Results The mean operative time was 70 minutes（55- 120min） ; blood loss, 90 ml （40-140ml）; no major complications such as infection, dural tear or nerve root compromise occurred during follow-up periods. VAS and ODI scores showed statistically significant improvements （P〈 0.01）. Postoperative CT scan demonstrating the decompression trajectory for spinal canal. Conclusion This microendoscopic unilateral approach for bilateral decompression may be appropriate for elderly patients with moderate symptoms of single-level lumbar spinal stenosis. Postoperative deterioration and recurrences are infrequent.

关 键 词：腰椎 椎管狭窄 内窥镜检查 外科手术 微创性 

分 类 号：R686[医药卫生—骨科学]