全脊柱内镜下治疗腰椎椎体后缘离断症  

Full-endoscopic technique for the treatment of posterior lumbar apophyseal ring fractures

作　　者：唐国柯 裴世深[2] 李大伟 黄庆华[1] 付军初 李丰 周文华[1] 吴罗根 马远征 TANG Guo-ke;PEI Shi-shen;LI Da-wei;HUANG Qing-hua;FU Jun-chu;LI Feng;ZHOU Wen-hua;WU Luo-gen;MA Yuan-zheng(Zhuzhou Hospital affiliated to XiangYa Medical College CSU,Zhuzhou,Hunan,412000,China)

机构地区：[1]中南大学湘雅医学院附属株洲医院,湖南412000 [2]衡水市第四人民医院脊柱骨科,河北053000 [3]中国人民解放军总医院第八医学中心骨科中心,北京100091

出　　处：《中国骨与关节杂志》2019年第10期783-787,共5页Chinese Journal of Bone and Joint

基　　金：湖南省技术创新引导计划-临床医疗技术创新引导项目(2017SK51001)

摘　　要：目的探讨全脊柱内镜下治疗腰椎椎体后缘离断症(posterior ring apophysis separation,PRAS)的效果。方法回顾性分析2014年12月至2017年12月于诊断为腰椎PRAS并行全脊柱内镜下手术治疗的31例临床资料,其中男24例,女7例;年龄12~41岁,平均(26.6±4.8)岁。其中L4~5椎间隙16例,L5~S1椎间隙15例;手术采用椎间孔入路21例,采用椎板间入路10例。利用疼痛视觉模拟评分(visual analogue scale,VAS)和腰椎活动度来评价临床效果并进行统计学比较。结果本组手术时间50~150 min,平均90 min,所有的患者均无硬膜或者神经根损伤,1例术后症状缓解不佳,2周后给予椎间融合手术翻修。其余30例均进行了至少12个月的随访,患者腰部疼痛VAS评分由术前的(5.42±2.72)分下降至术后即刻的(2.78±1.21)分,术后3个月的(1.78±0.56)分,术后12个月的(1.56±0.36)分;腿部疼痛VAS评分由术前的(6.78±2.44)分下降到术后即刻的(0.78±0.32)分,术后3个月的(0.65±0.12)分,术后12个月的(0.71±0.45)分,术后各时间点评分与术前比较差异均有统计学意义(P<0.05)。患者的腰椎活动度在手术前和手术后的差异无统计学意义(P>0.05)。结论全脊柱内镜下治疗腰椎PRAS能够明显缓解症状,并完整保留患者腰椎的活动度,中短期恢复良好。Objective To evaluate the feasibility and clinical outcomes of percutaneous full-endoscopic surgery in the treatment of posterior lumbar apophyseal ring fractures.Methods A total of 31 patients with posterior lumbar apophyseal ring fractures,including 24 males and 7 females aged 26.6 years on average(range:12-41 years),were treated by full-endoscopic technique.The responsible discs located at L4-5 in 16 and L5-S1 in 15.The transforaminal approach was used in 21 patients,while interlaminar approach was applied in the remaining 10 patients.VAS criteria were used to evaluate the clinical outcomes.Results The operation lasted for 90 min on average(range:60-170 min).A patient experienced poor postoperative remission and was given revision interbody fusion surgery two weeks later.No injury of nerve root or cauda equina occurred in anyone of the other patients.The remaining 30 patients were followed up for 12 months at least.VAS of low back pain significantly decreased from(5.42±2.72)preoperation to(2.78±1.21)post-operation,(1.78±0.56)three months later,and(1.56±0.36)twelve months later at the latest follow up(P<0.05).VAS of leg pain substantially reduced from(6.78±2.44)pre-operation to(0.78±0.32)post-operation,(0.65±0.12)three months later,and(0.71±0.45)twelve months later(P<0.05).All of the 30 patients achieved satisfactory remolding of the vertebral posterior rims on the MRI at 12 months after operation.The lumbar motion of the patients was not statistically different before and after surgery.Conclusions Posterior lumbar apophyseal ring fractures can be treated successfully with full-endoscopic surgery with satisfactory short-term results.

关 键 词：腰椎 内窥镜 椎体后缘离断 最小侵入性外科手术 

分 类 号：R681.5[医药卫生—骨科学] R687.3[医药卫生—外科学]