脊柱内镜减压治疗高龄腰椎退变性脊柱侧凸合并神经根管狭窄  

Endoscopic Decompression Surgery for Degenerative Lumbar Scoliosis Associated With Foraminal Stenosis in Elderly Patients

作　　者：李新锋[1] 王琨[1,2] 靳林煜 Li Xinfeng;Wang Kun;Jin Linyu(Department of Orthopedic Surgery,Baoshan Branch of Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200444,China)

机构地区：[1]上海交通大学医学院附属仁济医院宝山分院骨科,上海200444 [2]上海交通大学医学院附属仁济医院脊柱外科,上海200127 [3]北京大学人民医院脊柱外科,北京100044

出　　处：《中国微创外科杂志》2020年第2期151-155,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：上海宝山区科技创新专项资金(医学卫生项目)(19-E-40)。

摘　　要：目的探讨局麻下脊柱内镜减压治疗高龄腰椎退变性脊柱侧凸合并神经根管狭窄的疗效。方法局部麻醉下经椎间孔入路,从背侧和腹侧减压受压神经根。术后症状改善采用下肢痛视觉疼痛模拟评分(Visual Analogue Scale,VAS)和Oswestry功能障碍指数(Oswestry Disability Index,ODI)评估,手术疗效采用改良MacNab标准评估。结果术中1例硬膜撕裂,术后出现随体位变化的疼痛不适感,3周后症状改善。12例侧凸腰椎冠状面Cobb角39.3°±6.8°。12例随访(19.4±3.4)月。下肢痛VAS评分从术前(6.5±1.2)分,改善为末次随访(1.2±0.9)分(P=0.000)。ODI从术前(67.5±6.1)%,改善为末次随访(29.0±6.6)%(P=0.000)。末次随访改良MacNab标准优良率为83.3%(10/12)。结论高龄退变性腰椎侧凸合并神经根管狭窄的处理需要考虑患者自身条件,局麻脊柱内镜下减压能够有效缓解神经压迫症状,改善生活质量,是一种可供选择且安全有效的方法。Objective To investigate the endoscopic decompression effect on degenerative lumbar scoliosis associated with foraminal stenosis under local anaesthesia in elderly patients.Methods Twelve patients were given ventral and dorsal decompression of the nerve roots via percutaneous transforaminal endoscopic surgery under local anesthesia.The disability and pain improvement after operation were evaluated by using the visual analogue scale(VAS)and Oswestry disability index(ODI).The operative effect was analyzed by using the MacNab criteria.Results One patient suffered from dural laceration during operation.The pain and discomfort changed with the body position after the operation,and the symptoms were improved 3 weeks later.The Cobb angle of the coronal plane of lumbar scoliosis was 39.3°±6.8°in the 12 cases.The mean time of follow-ups in the 12 patients was(19.4±3.4)months.The VAS score of lower extremity pain was improved from(6.5±1.2)points before operation to(1.2±0.9)points at the last follow-up(P=0.000).The ODI was improved from(67.5±6.1)%to(29.0±6.6)%at the last follow-up(P=0.000).The excellent and good rate of modified MacNab standard was 83.3%(10/12)at the last follow-up.Conclusions The own conditions of the elderly patients should be considered for the management of degenerative lumbar scoliosis associated with foraminal stenosis.Endoscopic decompression under local anesthesia can effectively relieve the symptoms of nerve compression,and improve the quality of life of patients.Endoscopic surgery is proposed as a safe and effective alternative treatment for elderly patients with degenerative lumbar scoliosis associated with foraminal stenosis.

关 键 词：退变性脊柱侧凸 腰椎 神经根管狭窄 内镜 

分 类 号：R687.3[医药卫生—骨科学]