经皮全脊柱内镜经椎板间隙入路治疗中央型腰椎管狭窄症  

Percutaneous Total Spinal Endoscopy for Treatment of Central Lumbar Spinal Stenosis by Interlaminar Approach

作　　者：薛静波[1] 陈浩翔 李学林[1] 欧阳智华[1] 王程[1] 晏怡果[1] Xue Jingbo;Chen Haoxiang;Li Xuelin(Department of Spine Surgery, First Affiliated Hospital of University of South China, Hengyang 421001, China)

机构地区：[1]南华大学附属第一医院脊柱外科,衡阳421001

出　　处：《中国微创外科杂志》2020年第4期322-325,329,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：湖南省临床医疗技术创新引导项目(2017SK50202,2017SK50201);湖南省卫生计生委科研计划课题重点项目(A2017016);湖南省科技厅计划项目(2017SK4004);衡阳市科技计划项目(2018KJ115);湖南省卫生计生委B类课题(20180154);湖南省卫生计生委科研计划课题(C2017093)。

摘　　要：目的探讨经皮全脊柱内镜经椎板间隙入路治疗单节段中央型腰椎管狭窄症的临床疗效。方法2016年1月~2017年12月我科对腰椎中央管狭窄在连续硬膜外麻醉下行经皮全脊柱内镜椎板间隙入路椎管扩大减压术,采用疼痛视觉模拟评分(Visual Analogue Scale,VAS)、Oswestry功能障碍指数(Oswestry Disability Index,ODI)和MacNab标准评价疗效。结果26例均顺利完成手术。1例术中损伤撕裂硬膜囊,保守治疗后痊愈。1例术后出现单侧下肢一过性肌力下降,1例术后出现腰背部及双下肢疼痛症状。住院时间(6.4±2.1)d。腰痛术前VAS评分(7.5±0.8)分,显著高于术后第1天(3.4±0.6)分和术后12个月(1.7±0.7)分(P均=0.000)。腿痛VAS评分术前(7.3±0.8)分,显著高于术后第1天(4.0±0.7)分和术后12个月(1.7±0.7)分(P均=0.000)。术前ODI(77.8±4.6)%,显著高于术后1个月(45.4±4.6)%和术后12个月(8.8±2.9)%(P均=0.000)。术后12个月采用MacNab进行疗效评定:优14例,良10例,可2例,优良率92.3%(24/26)。结论经皮全脊柱内镜经椎板间隙入路治疗单节段腰椎中央管狭窄症,手术风险低,临床疗效满意。Objective To analyze the clinical efficacy of percutaneous total spine endoscopy in the treatment of single-segment central lumbar spinal stenosis.Methods Twenty-six patients with central lumbar spinal stenosis were treated in our hospital from January 2016 to December 2017.All the patients were operated under continuous epidural anesthesia.The operation was performed by percutaneous endoscopic interlaminar approach for spinal canal enlargement and decompression.The operation time,postoperative complications,and hospitalization time were observed and counted.The Visual Analogue Scale(VAS)and Oswestry Disability Index(ODI)were used to evaluate the efficacy of the patients before and after surgery.The MacNab standard was used to evaluate the efficacy at 12 months postoperatively.Results Twenty-six patients successfully underwent the operation,and one patient suffered from intraoperative injury to the dural sac.One of them had a transient lower extremity muscle strength after surgery and one patient developed symptoms of pain in the lower back and lower extremities after surgery.All patients were cured after conservative treatment.The hospitalization time of all patients was(6.4±2.1)d.The VAS score of low back pain was(7.5±0.8)points before operation,which was significantly higher than that on the first day after operation(3.4±0.6)points(P=0.000)and 12 months after operation(1.7±0.7)points(P=0.000).The VAS score of leg pain was(7.3±0.8)points before operation,which was significantly higher than that on the first day after operation(4.0±0.7)points(P=0.000),and 12 months after operation(1.7±0.7)points(P=0.000).The ODI was(77.8±4.6)%preoperatively,which was distinctly higher than that 1 month after operation(45.4±4.6)%(P=0.000)and 12 months after operation(8.8±2.9)%(P=0.000).The evaluation with the MacNab standard at 12 months postoperatively showed excellent in 14 cases,good in 10 cases,and moderate in 2 cases.The excellent and good rate was 92.3%(24/26).Conclusion Percutaneous total spinal endoscopy for the

关 键 词：中央型腰椎管狭窄症 全脊柱内镜 脊柱手术 

分 类 号：R68[医药卫生—骨科学]