经皮脊柱内镜治疗下腰椎椎体后缘离断症短期疗效  

Short-term efficacy in the treatment of lumbar posterior apophyseal ring separation by percutaneous endoscopic spine surgery

作　　者：冯品[1] 张斌[1] 刘俊麟 马俊松 孔清泉[2] FENG Pin;ZHANG Bin;LIU Jun-lin;MA Jun-song;KONG Qing-quan(Department of Orthopedics, Tibetan Chengdu Office Branch Hospital of West China Hospital,Sichuan University,Chengdu,Sichuan,610041,China)

机构地区：[1]四川大学华西医院西藏成办分院骨科,成都610041 [2]四川大学华西医院骨科,成都610041

出　　处：《中国骨与关节杂志》2019年第2期105-109,共5页Chinese Journal of Bone and Joint

摘　　要：目的探讨经皮脊柱内镜治疗下腰椎椎体后缘离断症的短期疗效。方法 2016年10月至2018年3月,我科采用经皮脊柱内镜治疗下腰椎椎体后缘离断症54例,其中男38例,女16例;年龄18～49岁,平均28.6岁。27例有明确腰部外伤史。其中L_(4～5) 21例,L_5～S_1 33例。单独位于L_4椎体后下缘5例,L5椎体后上缘14例,L_5椎体后下缘7例,S_1后上缘24例,位于L_4后下缘及L_5后上缘2例,位于L_5后下缘及S_1后上缘2例。突出骨块位置单独位于中央椎管区13例,位于中央椎管区+侧方椎管区23例,单独位于侧方椎管18例。均采用症状侧椎间孔或椎板间入路,镜下摘除突出椎间盘、去除部分或全部骨块。术后根据MacNab疗效评定标准进行评价。结果术中手术顺利,无中转开放、神经根损伤、硬膜囊撕裂等并发症。手术时间35～100 min,术中透视3～15次,术中出血量约10～50 ml。术后影像学提示减压彻底,部分切除14例,完全切除40例。患者均获得随访,随访时间7～24个月,平均13个月。术后根据MacNab疗效评定标准,优45例,良7例,可2例,优良率96.2%。结论经皮内镜治疗下腰椎椎体后缘离断症具有出血少、创伤小、破坏少、恢复快等优点,近期效果较好,同时结合中央椎管及侧隐窝功能分型,可以进一步指导手术方案,其远期效果有待进一步观察。Objective To explore the short-term effects and surgical experience of lumbar posterior apophyseal ring separation by percutaneous endoscopic spine surgery. Methods Between October 2016 and March 2018, 54 patients with lumbar posterior apophyseal ring separation were treated with percutaneous endoscopic spine surgery. There were 38 males and 16 females, aged from 18 to 49 years (mean: 28.6 years). There were 27 patients with definite waist trauma history. Among the 54 patients, 21 patients were injured at L4-5 and 33 patients were injured at L5-S1. Five cases injured at L4 posterior lower margin, 14 cases injured at L5 posterior upper margin, 7 cases injured at L5 posterior lower margin, 24 cases injured at S1 posterior upper margin, 2 cases injured at L4-5 posterior margins, 2 cases injured at L5-S1 posterior margins. Herniated bone mass located in the central spinal canal alone in 13 cases, the central spinal canal + lateral spinal canal in 23 cases, the lateral spinal canal alone in 18 cases. Intervertebral disc, some or all bone fragments were removed by percutaneous spinal endoscopy through symptomatic interlaminar or transforaminal approach. According to MacNab criteria, the postoperative effectiveness was evaluated. ResultsAccurate positioning was obtained in all patients during operation. There were no complications such as open surgery conversion, nerve root injury or dural sac laceration. The operation time was (35-100) minutes;the intraoperative fluoroscopy (3-15) times, and the blood loss (10-50) ml. Postoperative radiographic examination showed that the compression was all removed. 14 separation bone fragments were partly removed and 40 separation bone fragments were completely removed. All patients were followed up 7-24 months (median: 13 months). Evaluating the effectiveness according to MacNab criteria: 45 cases excellent, 7 cases good, 2 cases fair, the excellent and good rate was 96.2%. Conclusions Percutaneous endoscopic spine surgery is less invasive with less bleeding and rapid recovery in th

关 键 词：腰椎 脊柱疾病 内窥镜 最小侵入性外科手术 

分 类 号：R616.5[医药卫生—外科学] R681.5[医药卫生—临床医学]