经皮内镜治疗单节段腰椎管狭窄症的临床疗效分析  

Clinical results of percutaneous endoscopic decompression for single segmental lumbar spinal stenosis

作　　者：付强[1] 李军[1] 刘彦斌[1] 王传锋[1] 魏显招[1] 毛宁方[1] 陈誉[1] 

机构地区：[1]第二军医大学附属长海医院脊柱外科,上海200433

出　　处：《中国骨与关节杂志》2016年第5期375-379,共5页Chinese Journal of Bone and Joint

摘　　要：目的观察经皮内镜治疗单节段腰椎管狭窄症的临床疗效。方法 2011年10月至2014年8月,我科应用经皮内镜治疗单节段腰椎管狭窄症患者67例,其中男32例,女35例;年龄34-78岁,平均（61.3±11.9）岁;手术方式：椎板间入路45例,经椎间孔入路22例;分别于术前、术后3天、1周、1个月、3个月、6个月进行腰腿痛视觉模拟评分（visual analogue scale,VAS）和Oswestry功能障碍指数（oswestry disability index,ODI）评估,采用改良Mac Nab标准进行临床疗效评定。结果所有病例均顺利完成手术和各时间点评估,随访6-14个月,平均（10.2±2.2）个月;手术时间60-125 min,平均83.5 min,术中出血量10-50 ml,平均25 ml。术前、术后3天、1周、1个月、3个月、6个月的腰痛VAS评分别为（6.42±0.94）分、（3.76±0.53）分、（3.28±0.51）分、（2.88±0.62）分、（2.45±0.38）分、（2.21±0.39）分,腿痛VAS评分别为（6.23±0.87）分、（3.52±0.48）分、（3.27±0.61）分、（2.72±0.49）分、（2.43±0.31）分、（2.35±0.30）分,ODI评分分别为（70.48±7.61）分、（38.84±3.49）分、（35.67±2.33）分、（32.19±2.09）分、（31.34±2.31）分、（30.83±1.90）分,3项指标术后各时间点与术前比较,差异有统计学意义（P〈0.01）;末次随访Mac Nab疗效评价：优49例,良12例,可6例,优良率为91%。术中硬膜囊撕裂2例,术后感觉异常3例,未出现感染、神经根损伤、椎管内血肿等并发症。结论经皮内镜可以实现对单节段腰椎管狭窄症的有效减压,具有手术创伤小、恢复快、疗效满意等优点。但须根据狭窄部位选择手术入路,并对手术设备及技巧要求较高。Objective To describe and evaluate the indication and clinical outcomes of percutaneous endoscopic decompression （ PED ） techniques for single segmental lumbar spinal stenosis. Methods From September 2011 to August 2014, 67 cases （ 32 males and 35 females ） were treated with percutaneous endoscopic decompression surgery. The mean age was （ 61.3 ± 11.9 ） years. Forty-five cases were treated with interlaminar approach and the other 22 cases were with transforaminal approach. Visual analogue scale （ VAS ） and Oswestry disability index （ ODI ） were used for evaluation before and 3 days, 1 week, 1 month, 3 months and 6 months after surgery, and the clinical efficacy was evaluated by modified Macnab criteria. Results All cases were followed up for 6 - 14 （ 10.2 ± 2.2 ） months. The mean operation time was 83.5 min, blood loss was 25 ml. At the final follow-up, VAS for back and leg, ODI score were significantly improved than that of preoperative scores. According to MacNab, ＂excellent＂ was found in 49 cases （ 73.1% ）, ＂good＂ in 12 cases （ 17.9% ）, and ＂fair＂ in 6 cases （ 9.0% ）, the rate of excellence and good was 91%. Conclusions Percutaneous endoscopic decompression surgery is effective for single segmental lumbar spinal stenosis, meanwhile, there are many advantages in reduced traumatization, rehabilitation period and the outcome is satisfactory. During the surgery, surgical approaches need to be adjusted according to the site of stenosis, which need high requirements of surgical equipment and techniques.

关 键 词：外科手术 微创性 内窥镜 腰椎 椎管狭窄 

分 类 号：R687.3[医药卫生—骨科学]