经皮椎间孔镜单侧入路双侧减压治疗椎间盘突出致腰椎管狭窄症  

Percutaneous transforaminal endoscopic bilateral decompression via unilateral approach for lumbar spinal stenosis caused by lumbar disc herniation

作　　者：汤锋武[1] 符锋[1] 蒋显锋[1] 韩广[1] 云晨[1] 张赛[1] 

机构地区：[1]武警后勤学院附属医院神经外科,天津300162

出　　处：《中华神经外科杂志》2016年第12期1234-1238,共5页Chinese Journal of Neurosurgery

摘　　要：目的评价应用经皮椎间孔镜单侧入路双侧减压治疗椎间盘突出致腰椎管狭窄症（LSS）的临床效果。方法回顾性分析2014年1月至2016年1月武警后勤学院附属医院神经外科采用经皮椎间孔镜单侧入路双侧减压治疗的椎间盘突出致LSS患者，共35例。术后3个月应用改良Maenab标准评定手术疗效，术后6个月采用疼痛视觉模拟评分（VAS）和Oswestu功能障碍指数（ODI）评价手术疗效；根据MRI轴位参数，应用MxLiteViewDICOMViewer软件测量手术前后椎管面积的变化。结果35例患者手术平均用时（89．1±8．7）min。术前、术后6个月的VAS分别为（7．9±0．8）、（2．1±0．5）分，ODI分别为（61．5±3．7）、（21．3±2．1），差异均有统计学意义（均P〈0．05）。35例患者术后3个月Macnab疗效评定结果显示，优19例（54．4％），良13例（37．1％），可2例（5．7％），差1例（2．9％），优良率为91．4％。与术前比较，术后L3-4、L4-5、L5-S1的椎管面积分别增加（35．7±8．5）mm2、（40．9±4．1）mm2、（42．5±9．1）mm2。术后无硬脊膜破裂，无神经、血管、肠管损伤，无感染病例。最常见的并发症为神经根瞬时感觉异常。结论经皮椎间孔镜单侧入路双侧减压术治疗椎间盘突出致LSS短期疗效好，术后腰椎管的稳定性、再狭窄的风险，以及再狭窄后是否需要再次手术需要进一步的长期观察。Objective To evaluate the clinical results of percutaneous transforaminal endoscopic bilateral decompression （PTED）via unilateral approach for lumbar spinal stenosis （LSSS） caused by lumbar disc herniation （LDH）. Methods From January 2014 to January 2016, 35 cases of LSS caused by LDH were treated with PTED via unilateral approach at Affiliated Hospital of Logistics University of Chinese Armed Police Force, and their data were used for a retrospective analysis. The surgical effect was evaluated using the Maenab score at 3 months post-operation. Visual analogue scale （ VAS ） and Oswestry disability index （ODI）were used to assess the outcomes at 6 month post-operation. MxLiteView DICOM Viewer software was used to measure the change of spinal canal area before and after operation based on the parameters of axial MRI images. Results The mean operation time was （89. 1 ±8. 7 ） rain in 35 patients. The preoperative and 6-month postoperative VAS values were （7. 9 ± 0. 8） and （2. 1 ± 0. 5） points, respectively, and the ODI were（61.5± 3.7） and （21.3 ± 2.1 ） points, respectively. Both differences were statistically significant （P 〈0.05）. As per the Macnab criteria, 19 patients （54.4%） reported excellent effect, 13 （37. 1%） demonstrated good outcome, 2 （5. 7%） reported faireffect, and 1 （2. 9%） demonstrated poor result. The excellent/good rate reached 91. 4%. Compared with the preoperative conditions, the cross sectional areas of spinal canal at the levels of L3 -4, L4-5 and L5 -Slwere increasedby （35.7 ± 8.5 ） mm2, （40.9± 4.1 ） mm2 and （42.5 ± 9.1 ） mm2, respectively. No postoperative rupture of spinal dura, or injury of nerves, blood vesselsas well as intestines, or infection occurred in this series. The most frequently observed complication was transient paresthesia due to irritation of nerve root. Conclusions The procesure of PTED via unilateral approach demonstrate satisfactory short-term effect in the treatment of LSS caused by LDH. Furth

关 键 词：椎管狭窄 腰椎 减压术 外科 经皮椎间孔镜 单侧入路双侧减压术 

分 类 号：R687.3[医药卫生—骨科学]