经关节突全内镜侧隐窝减压的临床应用  

Surgical design and clinical application of percutaneous full-endoscopic lumbar decompression for lateral recess stenosis through articular process

作　　者：付瑶 廖文波[1] 伍富俊 辛志军[1] 石超 FU Yao;LIAO Wen-bo;WU Fu-jun;XTN Zhi-jun;SHI Chao(Department of Spine Surgery,the Affiliated Hospital of Zunyi Medical College,Zunyi,Guizhou,563000,China)

机构地区：[1]贵州遵义医学院附属医院脊柱外科,563000

出　　处：《中国骨与关节杂志》2019年第2期127-131,共5页Chinese Journal of Bone and Joint

摘　　要：目的观察后路经关节突全内镜下侧隐窝减压治疗单节段侧隐窝型腰椎管狭窄症的临床疗效。方法收集2013年9月至2015年9月,我科符合纳入标准的单节段侧隐窝型腰椎管狭窄症患者共25例,其中男18例,女7例,年龄56～76岁,平均(66.32±5.20)岁。病变节段:L_(4～5) 18例,L_5～S_1 7例。所有患者均采用后路经关节突入路全内镜下侧隐窝减压技术,对引起临床症状的责任区域进行精准减压。术前、术后次日及末次随访时患者的腰痛及坐骨神经痛采用疼痛视觉模拟评分(visual analogue score,VAS)评估,患者腰椎功能情况使用Oswestry功能障碍指数(oswestry disability index,ODI)评估,通过改良MacNab评分对末次随访进行评估,评价临床疗效。结果所实施手术均顺利完成,手术时间为76～103 min,平均(90.96±7.06)min,术中出血量5～10 ml,平均(6.04±1.34)ml。术后1周复查腰椎CT及MRI,结果显示侧隐窝减压彻底。随访时间为24～37个月,平均(28.80±3.52)个月。患者腰痛VAS评分在术前、术后次日和末次随访时分别为(6.92±0.91)分、(3.48±0.77)分、(2.00±0.96)分;坐骨神经痛VAS评分在术前、术后次日、末次随访分别为(7.24±0.78)分、(3.28±0.76)分、(1.92±0.91)分;ODI术前、术后次日和末次随访分别为80.40±3.92、58.96±3.66、29.44±4.34。术后腰痛及坐骨神经痛VAS及ODI均较术前显著降低,差异有统计学意义(P<0.05)。末次随访以改良MacNab疗效评价:优19例,良5例,可1例,优良率为96%。结论经关节突全内镜侧隐窝精准减压是治疗侧隐窝型腰椎管狭窄症的一种微创、有效的术式。Objective To observe the clinical effects of posterior full-endoscopic lumbar decompression for the treatment of single-segment lateral crypt lumbar spinal stenosis (LSS). Methods A total of 25 patients (18 males, 7 females) with single-segment LSS were recruited from September 2013 to September 2015, including 18 cases on L4-5, 7 cases on L5-S1. Patients’ age ranged from 56 to 76 years, with an average of (66.32 ± 5.20) years. All patients were treated with percutaneous full-endoscopic lumbar decompression through articular process to decompress accurately. Outcomes were evaluated at pre-operation, the next morning after the operation, and at the last follow-up. Low back pain and sciatica were measured by visual analogue scale (VAS) score. Function outcomes were assessed by oswestry disability index (ODI) and modified MacNab criteria. Results All patients completed the operation successfully. The operation time was 76-103 min, with an average of (90.96 ± 7.06) min. The intraoperative blood loss was (5-10) ml, and the average blood loss was (6.04 ± 1.34) ml. Lumbar CT and MRI were performed 1 week postopratively, and the results showed that the lateral recess was fully decompressed. The follow-up time was 24-37 months, with an average of (28.80 ± 3.52) months. Low back pain VAS scores: (6.92 ± 0.91) preoperatively, (3.48 ± 0.77) the next morning after the operation, (2.00 ± 0.96) at the last follow-up. Sciatica VAS scores: (7.24 ± 0.78) preopratively, (3.28 ± 0.76) the next morning after the operation, (1.92 ± 0.91) at the last followup. ODI scores showed a decrease from (80.40 ± 3.92) preoperatively to (58.96 ± 3.66) at the next morning, and (29.44 ± 4.34) at the last follow-up. VAS and ODI scores were significantly lower after the surgery (P < 0.05). The MacNab efficacy evaluation showed improvement at the end of the follow-up: 19 cases were excellent, 5 cases were good, 1 case was fair, with a good/excellent rate of 96%. Conclusions Percutaneous full-endoscopic lumbar accurate decompression thro

关 键 词：内窥镜 椎管狭窄 椎关节突关节 最小侵入性外科手术 减压术 外科 

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