经皮脊柱内镜治疗腰椎椎体后缘骨骺离断症的临床疗效  

Clinical observation of transdermal spinal endoscopy in the treatment of epiphysis of lumbar posterior vertebral body

作　　者：王想福[1] 陈伟国 叶丙霖[3] 李晨旭[1] 范有福[1] 孙凤歧[1] 赵恒 朱生虎 WANG Xiang-fu;CHEN Wei-guo;YE Bing-lin;LI Chen-xu;FAN You-fu;SUN Feng-qi;ZHAO Heng;ZHU Sheng hu(Gansu University of Chinese Medicine,Lanzhou,Gansu,730050,China)

机构地区：[1]甘肃省中医院脊柱微创骨科,兰州730050 [2]甘肃中医药大学,兰州730000 [3]甘肃省中医药研究院,兰州730050

出　　处：《中国骨与关节杂志》2019年第2期110-114,共5页Chinese Journal of Bone and Joint

基　　金：兰州市科学技术局项目(2017-4-72)

摘　　要：目的观察经皮脊柱内镜技术治疗腰椎椎体后缘骨骺离断症的临床疗效。方法 2014年8月至2017年8月,我科运用经皮脊柱内镜治疗并随访32例腰椎椎体后缘骨骺离断的患者,其中男15例,女17例;年龄17～44岁,平均30.5岁。病变节段L_(2～3) 1例、L_(3～4) 2例、L_(4～5) 16例、L_5～S_1 13例。在经脊柱内镜治疗时L_(2～3)、L_(3～4)和L_(4～5)节段采用经椎间孔入路,L_5～S_1节段运用经椎板间入路进行手术。术后采用疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(oswestry disability index,ODI)、改良MacNab对其进行临床疗效评价。结果本组32例均获得随访,随访时间6～36个月,平均15.5个月,平均手术时间(74.6±7.4) min。术后所有患者腰部疼痛,腿部疼痛、麻木,下肢感觉异常、肌力减退较术前均有不同程度的缓解。术后所有患者未发现严重手术并发症。1例术后3个月出现责任间隙腰椎间盘突出,采用经皮脊柱内镜手术翻修。VAS评分术前(6.33±1.63)分,术后3个月(3.67±1.34)分,术后6个月(1.45±0.82)分,术后12个月(0.93±0.31)分;术后不同时间段与术前VAS评分比较,差异均有统计学意义(P<0.05)。ODI评分术前(48.84±11.33)分,术后3个月(31.27±12.08)分,术后6个月(19.86±6.37)分,术后12个月(10.37±5.1)分。术后不同时间段与术前ODI评分比较,差异均有统计学意义(P<0.05)。末次随访时运用MacNab评价临床疗效,优23例、良8例、可1例,优良率96.9%。结论经皮脊柱内镜技术治疗腰椎椎体后缘骨骺离断症具有损伤小、出血少、安全性高、保留运动节段、术后并发症少、疗效确切等优点,其近期临床疗效满意。Objective To observe the clinical efficacy of percutaneous spinal endoscopy in the treatment of epiphysis of lumbar vertebra posterior margin. Methods A total of 32 patients with epiphysis of the posterior margin of lumbar vertebra had been treated with percutaneous spinal endoscopy between August 2014 and August 2017. There were 15 males and 17 females with the mean age of 30.5 years (range: 17-44 years). Locations: 1 case in L2-3, 2 cases in L3-4, 16 cases in L4-5, 13 cases in L5-S1. L3-4 and L4-5 segments were operated by intervertebral foramen approach, while L5-S1 segments were operated by interlaminar approach. Visual analogue scale (VAS), Oswestry dysfunction index (ODI) and modified MacNab were used to evaluate clinical efficacy. Results All 32 patients were followed up for 6-36 months, with an average of 15.5 months. The mean operation time was (74.6 ± 7.4) min. Postoperative lumbar pain, leg pain, numbness, lower limb paresthesia and muscle weakness were all relieved to different degrees. No serious postoperative complications were found in all patients. One patient developed lumbar intervertebral disc herniation in the responsible interval 3 months after surgery and underwent percutaneous spinal endoscopic surgery. VAS scores: (6.33 ± 1.63) before surgery, (3.67 ± 1.34) 3 months after surgery, (1.45 ± 0.82) 6 months after surgery, (0.93 ± 0.31) 12 months after surgery, statistically significant at different time periods (P < 0.05). ODI score: (48.84 ± 11.33) before surgery, (31.27 ± 12.08) 3 months after surgery, (19.86 ± 6.37) 6 months after surgery, (10.37 ± 5.1) 12 months after surgery, statistically significant at different time periods (P < 0.05). At the last follow-up, MacNab was used to evaluate the clinical efficacy: excellent in 23 cases, good in 8 cases and fair in 1 case, excellent and good rate 96.9%. Conclusions Percutaneous spinal endoscopy is less invasive with less bleeding, less postoperative complications, higher safety, better motion segment retaining, and definite curative

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]