经皮椎板间入路内镜下椎管减压治疗老年腰椎侧隐窝狭窄症  

Percutaneus endoscopic interlaminar decompression for lumbar lateral recess stenosis in elderly patients

作　　者：陈康[1] 曾建成[1] 修鹏[1] 王亮[1] 谢天航 杨志强 宋跃明[1] Chen Kang;Zeng Jiancheng;Xiu Peng;Wang Liang;Xie Tianhang;Yang Zhiqiang;Song Yueming(Department of Orthopaedic, West China Hospital of Sichuan University, Chengdu 610041, China)

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中华骨科杂志》2018年第8期458-467,共10页Chinese Journal of Orthopaedics

基　　金：成都市科技惠民技术研发项目（2015-HM01-00637-SF）;四川大学华西医院学科卓越发展135工程项目（ZY2016204）;四川省科技厅项目（2017FZ0093）

摘　　要：目的 探讨经皮椎板间入路内镜下椎管减压治疗老年腰椎侧隐窝狭窄症的临床疗效及其手术技巧。方法 2014年5月至2015年6月收治老年腰椎侧隐窝狭窄症患者76例,男48例,女28例,年龄60~91岁,平均（71.7±8.8）岁。L 4,5节段40例,L 5S1节段29例,L 4,5、L 5S1双节段7例。均采用经皮椎板间入路内镜下椎管减压术。记录手术时间、术中及术后并发症等。采用疼痛视觉模拟评分（visual analogue scale,VAS）评估腰痛及腿痛,采用Oswestry功能障碍指数（Oswestry disability index,ODI）评估腰椎功能。末次随访时采用MacNab标准评估临床疗效。影像学评价采用骨性侧隐窝角、软性侧隐窝角评估椎管减压程度,采用上关节切除率评估上关节突切除量,采用腰椎动力位X线片评估腰椎稳定性。结果 所有患者均顺利完成手术,手术时间56~98min,平均（64.3±23.9） min。术后随访24~36个月,平均（31.5±4.8）个月。术后1、3、6、12个月及末次随访时腰痛VAS评分 、腿痛VAS评分及ODI较术前有明显改善（P 〈0.05）。末次随访时MacNab 标准评估：优52例、良 18例、可6例,优良率为92.1%。术后骨性侧隐窝角、软性侧隐窝较术前有统计学差异（P 〈0.05）。术中1例发生蓝钳剪破硬膜囊,2例L 5神经根外膜撕裂;麻醉清醒后1例发生短暂性抽搐;术后1例感觉异常,1例出现谵妄,经积极对症治疗后圴得以缓解。1例手术切口愈合延迟。随访期间3例出现椎间失稳,失稳率为3.9%。术中无一例发生手术节段错误、神经根撕裂。术后无一例发生椎间隙感染、脑脊液漏病例。结论 采用经皮椎板间入路内镜下椎管减压治疗老年腰椎侧隐窝狭窄症,能免精准减压骨性侧隐窝狭窄、高效切除黄韧带减压软性侧隐窝狭窄,具有早期临床疗效确切、对脊柱稳定性影响小,并发症低等特点,是安全、有效的微创治疗方案。Objectives To assess the clinical outcomes, the technical characteristics of percutaneus endoscopic interlaminar decompression for lumbar lateral recess stenosis in elderly patients. Methods From May 2014 to June 2015, 76 elderly patients with lumber lateral recess stenosis were accepted percutaneus endoscopic interlaminar decompression, including 48 males and 28 females aged from 60-91 years old （average, 71.7±8.8 years）. There were 40 patients with stenosis in L 4,5, 29 patients with stenosis in L 5S1 and 7 patients with stenosis in L 4,5 and L 5S1. Back and leg pain were assessed by visual analogue scale （VAS）. The influence of pain was evaluated by Oswestry disability index （ODI）. The change of spinal canal was assessed by lateral recess angle. The MacNab criteria was evaluated at last follow-up. Results All of the 76 operations had been completed successfully with an average operation time of 64.3±23.9 min （range, 56-98 min）. An average follow-up time was 31.5 months （range, 24-36 months）. There was no operative segment errors and nerve root tear during operation. Dural sac tear in 1 case, 2 cases of nerve root injury and 1 case of postoperative kakesthesia, transient seizures after anesthesia occurred in 1 case and 1 case had postoperative delirium. There were significances in lumbocrural pain scores, leg pain scores and ODI scores between preoperation and postoperative 1,3,6,12 month and last follow-up （P〈0.05）. In the MacNab last follow-up, the fineness rate was 92.1%, including 52 cases of excellence, 18 cases of good, and 6 cases of fair. The latera recess angle between preoperation and postoperation was significantly different. During follow-up period, there were 3 cases developed into lumbar instability. No recurrence, discitis and leakage of cerebrospinal fluid were found, delayed incision healing was found in 1 case. Conclusions Percutaneus endoscopic interlaminar decompression for lumbar lateral recess stenosis in elderly patients is a safe, effective and minimally invas

关 键 词：腰椎 椎管狭窄 黄韧带 内窥镜检查 老年人 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]