椎间孔镜结合可变向磨钻治疗老年性腰椎管狭窄症  

Efficacy of transforaminal endoscopy for treatment of senile degenerative lumbar stenosis using direction changeable burr

作　　者：尹国栋 林舟丹[1] 程昌志[1] 王充 李贵谦[1] 张立杰 

机构地区：[1]解放军第303医院脊柱外科,南宁530021

出　　处：《中国矫形外科杂志》2018年第5期458-462,共5页Orthopedic Journal of China

基　　金：广西自然科学基金项目(编号：2017GxNSFAA198364)

摘　　要：[目的]探讨侧后方入路椎间孔镜技术配合可变向动力磨钻治疗腰椎管狭窄症。[方法]回顾分析本院2015年7月～2017年1月收治的32例老年腰椎管狭窄症患者病例资料,均为一侧侧隐窝狭窄症状。收集患者术前与随访时间节点X线片、CT和MRI等影像资料。分别于术前及术后1 d、3个月和末次随访时采用Oswestry功能障碍指数(Oswestry disability index,ODI)、视觉疼痛模拟评分(visual analogue scale,VAS)与改良MacNab疗效评定标准对临床疗效进行分析评估。[结果]32例患者行椎间孔入路手术,平均病程19.83个月,手术节段:L_5/S_1节段11例,L_(4/5)节段18例,L_(3/4)节段3例。术中使用骨钻、咬钳与可变向磨除去除上关节突腹侧、黄韧带、椎间盘并充分扩大侧隐窝。术后平均随访时间6.43个月。术后及随访时ODI评分与VAS评分均较术前明显改善,差异有统计学意义(P<0.01),术后复查腰椎CT与MRI证实,侧隐窝及神经根减压充分。改良MacNab疗效评定标准,优21例,良7例,可3例,差1例,优良率87.50%。[结论]椎间孔镜技术结合可变向磨钻治疗老年性腰椎管狭窄症可获得较好的临床效果。[Objectives] To investigate the indication, surgical technique and outcomes of transforaminal endoscopy for treatment of senile lumbar degenerative stenosis combined with use of direction changeable burr. [Methods] From July 2015 to January 2017,32 senile patients with lumbar degenerative stenosis were included in this retrospective study. All the patients were taken anterior-posterior, lateral, excessive flexion and extension cervical spine X-ray, CT scan as well as MRI. The clini- cal efficacy was evaluated using the Oswestry disability index （ODI）, visual analogue scale （VAS）, and modified MacNab crite- ria. [Results] All of the 32 patients with disease course of 19.8 months on average received a transforaminal endoscopy, in which the lateral recess and nerve root were decompressed by removing the ventral part of the superior facet joint, the ligamen- turn flavum and the intervertebral disc using a direction changeable burr through the affected intervertebral spaces, including L5/S1 in 11, L4/5 in 18 and L3/4in 3 cases. The patients were followed up for an average of 6.4 months. Compared with those before op- eration, both the ODI and VAS significantly decreased at different time points postoperatively, with statistical differences among the time points （P〈0.01）. At the latest follow up, the results graded as excellent in 21, good in 7, fair in 3 and poor in 1 patient, with the excellent and good rates of 87.5% according to the MacNab criteria. [Conclusions] Transforaminal endoscopy, com- bined with using a direction changeable burr, does efficiently treat senile lumbar stenosis.

关 键 词：椎间孔镜 可变向磨钻 腰椎管狭窄症 侧隐窝 

分 类 号：R681.57[医药卫生—骨科学]