经椎间孔经皮内镜治疗中央型腰椎管狭窄症  

Percutaneous transforaminal microendoscopy for treatment of lumbar central spinal canal stenosis

作　　者：黄保华[1] 钟远鸣[1] 陈远明[2] 黄中飞[2] 黄剑峰 

机构地区：[1]广西中医药大学第一附属医院脊柱外科,南宁530023 [2]广西中医药大学附属瑞康医院脊柱外科,南宁530011 [3]广西贺州市中医院脊柱外科,542800

出　　处：《中国矫形外科杂志》2018年第1期79-83,共5页Orthopedic Journal of China

摘　　要：[目的]探讨经椎间孔经皮内镜治疗中央型腰椎管狭窄症的早期疗效。[方法]2013年6月~2015年8月对23例诊断为中央型腰椎管狭窄症患者,采用经椎间孔经皮内镜进行椎管扩大成形+腰椎间盘摘除术+神经根管减压术,采用腰痛VAS评分、腿痛VAS评分、Oswestry功能障碍指数和改良Macnab疗效标准评价早期疗效。[结果]22例顺利完成手术,1例因疼痛、不能长时间俯卧转为开放手术。手术时间50~125 min,术中透视次数4~16次,术中出血量5~20 ml。21例获得随访,随访时间(14.50±5.25)个月(10~25个月)。术前腰痛VAS评分为(5.90±1.21)分,术后即刻腰痛VAS评分为(2.81±1.10)分,术后3个月为(2.63±0.91)分,术后1年随访时为(2.36±0.83)分,与术前时比较差异均有统计学意义(P<0.05)。术前腿痛VAS评分为(5.73±1.54)分,术后即刻腿痛VAS评分为(2.61±1.02)、术后3个月为(2.43±0.80)分,术后1年随访时为(2.30±0.61)分,与术前比较差异均有统计学意义(P<0.05)。ODI评分术前为(70.86±15.27)%,术后即刻为(29.66±12.45)%、术后3个月为(28.64±10.26)%、术后1年随访时为(20.56±5.72)%,与术前比较差异均有统计学意义(P<0.05),采用改良Macnab疗效评定标准:优8例,良9例,可3例,差1例,优良率为81.00%。1例(4.80%)患者术后3个月行开放手术。[结论]经椎间孔经皮内镜治疗中央型腰椎腰椎管狭窄症具有创伤小、出血少、康复快等优势,近期效果满意,远期效果需进一步随访。[Objective] To explore the short-term outcome of percutaneous transforaminal microendoscopy for treatment of lumbar central spinal canal stenosis. [Methods] From May 2013 to August 2015, a total of 23 patients with central lumbar spi- nal canal stenosis underwent the percutaneous transforaminal microendoscopy for spine canal decompression, discectomy, and nerve root release by the same surgeon team. The short-term outcome was evaluated using the VAS of low back pain and leg pain, Oswestry disability index and a modified Macnab＇s criterion. [Results] The operation was successfully completed in 22 pa- tients, whereas the remaining 1 patient was changed to open surgery due to intolerance to microendoscopy. The operation lasted for 50-125 rain, with intraoperative fluoroscopy of 4-16 times and intraoperative blood loss of 5-20 ml. Of them, 21 patients were followed up for a mean of 14 months ranged from 10 to 25 months. The low back pain VAS at the preoperative, immediately postoperative, 3 month postoperative and 1 year postoperative time points were （5.9± 1.2） , （2.8± 1.1） , （2.6±0.9） and （2.3± 0.8） , respectively, with statistically significant differences between the preoperative and different time points postoperatively separately （P〈0.05）. In addition, the leg pain VAS of the preoperative, immediate postoperative, 3 month postoperative and 1 year postoperative were （5.7±1.5）, （2.6±1.0）, （2.4±0.8） , and （2.3±0.6） individually, likewise with statistical differences be- tween the preoperative and different time points postoperatively （P〈0.05）. Furthermore, the ODI of the preoperative, immediate postoperative, 3 month postoperative and 1 year postoperative proved （70.8±15.2） %, （29.6±12.4） %, （28.6±10.2） % and （20.5±5.7）%, separately. There were statistical significance be- tween the preoperative and different time points postopera- tively （P〈0.05）. In term of modified Macnab criterion, excellent results were achieved in 8 patients, goo

关 键 词：腰椎管狭窄症 经皮椎间孔镜 

分 类 号：R681.57[医药卫生—骨科学]