椎间孔脊柱内镜治疗腰椎椎体后缘离断  

Spinal endoscopy via percutaneous transforaminal approach for lumbar posterior ring apophysis separation

作　　者：王长昇[1] 陈荣生[1] 朱希田 许卫红[1] 张立群[1] 吴荔军[1] Wang Changsheng;Cheng Rongsheng;Zhu Xitian;Xu Weihong;Zhang Liqun;Wu Lijun(Department of Spine Surgery,First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China)

机构地区：[1]福建医科大学附属第一医院脊柱外科,福州350005

出　　处：《中华创伤杂志》2019年第11期1006-1011,共6页Chinese Journal of Trauma

基　　金：福建省卫生计生委中青年骨干人才培养项目(2016-ZQN-49);福建省临床重点专科建设项目资助(闽卫科教[2012]149号)。

摘　　要：目的探讨经皮椎间孔入路脊柱内镜治疗腰椎椎体后缘离断(PRAS)的临床疗效.方法采用回顾性病例系列研究分析2016年9月-2018年3月福建医科大学附属第一医院收治的32例腰椎PRAS患者临床资料,其中男20例,女12例;年龄20~47岁[(33.7±6.6)岁].均为单节段病变,损伤节段:L3/47例,L4/514例,L5/S111例.均采用经皮椎间孔脊柱内镜治疗.记录切口长度、手术时间、术中出血量、术中C形臂X线机透视次数及手术并发症,术后24h、3个月、12个月采用腰、腿痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)、改良MacNab标准评定疗效.结果32例患者均获随访12~30个月,平均15.5个月.手术切口长度7~9.5 mm[(8.0±0.9)mmn];手术时间60~155 min[(80.5±13.2)min];术中出血量5~25 ml[(10.6±5.7)ml];透视次数5~25次[(9.4±3.4)次].患者术后8~12h下地行走,6周恢复正常工作及生活.1例患者术后出现感觉异常,经神经营养及理疗1周后恢复.术中无中转开放,无椎间隙感染、神经根损伤、硬脊膜撕裂等术后并发症.术后24h、3个月、12个月腰、腿痛VAS[腰痛(3.4±1.5)分、(1.8±1.1)分、(1.7±0.9)分,腿痛(1.8±1.0)分、(1.6±0.8)分、(1.4±0.6)分]和ODI[(26.8±9.7)%、(13.9±4.3)%、(12.8±2.8)%]较术前腰痛VAS(7.3±2.1)分、腿痛VAS(7.9±2.7)分、ODI(56.2±15.6)%明显改善(P<0.05).术后12个月按改良MacNab标准评估疗效:优25例,良5例,可2例,优良率为94%.结论经椎间孔脊柱内镜治疗腰椎PRAS疗效满意,具有手术切口小、并发症少、有效缓解疼痛、功能恢复快等优点.Objective To investigate the clinical efficacy of spinal endoscopic surgery for lumbar posterior ring apophysis separation(PRAS)via percutaneous transforaminal approach.Methods A retrospective case series study was conducted to analyze the clinical data of 32 patients with lumbar PRAS admitted to the First Affiliated Hospital of Fujian Medical University from September 2016 to March 2018.There were 20 males and 12 females,aged 20-47 years[(33.7±6.6)years].All patients had single-segment lesions.The injured segments were at L3/4 in seven patients,L4/5 in 14 patients,L5/S1 in 11 patients.All patients were treated with spinal endoscopic surgery via percutaneous transforaminal approach.The incision length,operation time,intraoperative blood loss,intraoperative fluoroscopy times of C-arm X-ray machine and operational complications were recorded.At 24 hours,3 months and 12 months after operation,the efficacy was evaluated by visual analogue score(VAS),Oswestry dysfunction index(ODI)and modified MacNab criteria.Results All patients were followed up for 12-30 months,with an average of 15.5 months.The incision length was 7-9.5 mm[(8.0±0.9)mm],the average operation time was 60-155 minutes[(80.5±13.2)minutes],the average intraoperative blood loss was 5-25 ml[(10.6±5.7)ml]and the average number of fluoroscopy was 5-25 times[(9.4±3.4)times].The patients were permitted to move wearing hard waist 8-12 hours after operation and returned to normal work and life 6 weeks after operation.Postoperative dysesthesia was noted in one patient,who recovered after neurotrophy and physiotherapy after one week.There were no complications such as open surgery conversion,intervertebral space infection,nerve root injury and dural sac laceration.The VAS and ODI at 24 hours,3 months and 12 months after operation[low back pain VAS:(3.4±1.5)point,(1.8±1.1)points,(1.7±0.9)points;leg pain VAS:(1.8±1.0)points,(1.6±0.8)points,(1.4±0.6)points;ODI:(26.8±9.7)%,(13.9±4.3)%,(12.8±2.8)%]were significantly improved compared with those before ope

关 键 词：腰椎 内窥镜 外科手术 微创性 

分 类 号：R68[医药卫生—骨科学]