偏心环锯技术在经皮内镜治疗腰椎侧隐窝狭窄症中的临床应用  

Eccentric reaming technique in percutaneous endoscopic lumbar discectomy in the treatment of lumbar lateral recess stenosis： a five-year case series study

作　　者：李海音 牟雪松 蓝蔚仁 蒋长青 张超 郑文杰 周跃 李长青 Li Haiyin;Mu Xuesong;Lan Weiren;Jiang Changqing;Zhang Chao;Zheng Wenjie;Zhou Yue;Li Changqing(Department of Orthopaedics,Xinqiao Hospital,Army Medical University,Chongqing 400038,China)

机构地区：[1]陆军军医大学附属新桥医院骨科,重庆400038

出　　处：《中华骨科杂志》2018年第16期996-1002,共7页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金（81572208）

摘　　要：目的探讨经皮内镜手术中应用偏心环锯技术治疗腰椎侧隐窝狭窄症的临床疗效及其安全性。方法回顾性分析2010年4月至2012年6月收治45例腰椎侧隐窝狭窄症患者的病历资料。男28例，女17例；年龄39～62岁，平均（49.23±23.96）岁。病变均为单节段，L4，5 25例，L 5S1 20例。均采用经皮内镜手术治疗，术中采用偏心环锯技术行关节突成形术。记录患者围手术期数据包括手术节段、手术时间、术中出血量。主要观察指标为Oswestry功能障碍指数（Oswestry disability index，ODI）及疼痛视觉模拟评分（visual analogue scale，VAS），分别于术前、术后第1天、术后1个月及末次随访时进行评估。随访期间观察包括腰椎间盘突出症复发、椎管内血肿、椎间隙感染、神经根损伤及神经根炎等术后并发症的发生。结果45例患者均顺利完成手术，无术中转为开放手术者；术中均顺利完关节突成形术，无需应用电动磨钻或其他设备，且顺利置入工作套管。手术时间45～76 min,平均（61.23±13.89）min；术中出血量10～25 ml，平均（15.02±4.33）ml。术后住院时间1～3 d，平均（2.80±1.57）d。随访时间为60～84个月，平均（73.25±8.47）个月。术后第1天ODI平均为9.34%±6.54%较术前68.06%±24.14%明显降低，但术后各随访时间点及末次随访时均无明显变化。术后第1天腰痛VAS评分平均为（1.54±0.97）分较术前（3.57±3.12）分明显较低，至末次随访时腰痛症状持续缓解；术后第1天下肢痛VAS评分平均为（1.14±0.79）分较术前（6.24±2.35）分明显降低，术后6个月内下肢痛症状持续缓解，下降至（0.54±0.23）分，至末次随访时维持良好。随访期间1例患者出现腰椎间盘突出复发（2.22%），无椎间隙感染、椎管内血肿及神经根炎等并发症。结论经皮内镜手术中应用偏心环锯技术行关节突成形术是一种安全的技术，能有�ObjectiveTo investigate clinical effect and safety of eccentric reamer technique foraminoplasty during percutaneous endoscopic lumbar discectomy for the treatment of lumbar lateral recess stenosis.MethodsAll of 45 cases diagnosed of lumbar lateral recess stenosis between Apr 2010 to Jun 2012 were analyzed in our study. Among these cases, 28 cases were male and 17 were female. The age of enrolled cases was 39-62 years old and the average age was 49.23±23.96 years old. All the cases were one-level, 25 cases in L 4,5 and 20 cases in L 5S1. All the patients underwent percutaneous endoscopic lumbar discectomy. During surgery, eccentric reamer technique was applied for foraminoplasty. Perioperative data included surgical segment, surgical duration and blood loss during surgery. Oswestry Disability Index （ODI） and Visual analogue scale （VAS） for lower back and leg pain were recorded for the evaluation of surgical effect. All the data were recorded before surgery, 1 day, 1 month after surgery and final follow-up. Recurrent lumbar disc herniation, spinal canal hematoma, intervertebral disc infection, nerve root injury and post-operative dysthesia （POD） were recorded for complications.ResultsAll the cases finished surgery and none of the cases was changed to other surgery method and no other electronic drill were used in these patients. Surgical duration was 45-76 min and average time was 61.23±13.89 min. Blood loss during surgery was 10-25 ml and average blood loss was 15.02±4.33 ml. Post-operative hospitalization days were 1-3 days and 2.80±1.57 days. The follow-up time was 60-84 months and the average time was 73.23±8.47 months. ODI in one-day after surgery was 9.34±6.54%, significantly lower than 68.06±24.14% before surgery and no statistically change had been observed in one-month after surgery and final follow-up. The VAS for lower back was 1.54±0.97 in one-day after surgery, significantly lower than 3.57±3.12 before surgery. The VAS for leg pain was 1.14±0.79 in one-day after surgery, significa

关 键 词：腰椎 椎管狭窄 内窥镜检查 外科手术 微创性 

分 类 号：R687.3[医药卫生—骨科学]