可视化四象限三级关节突成形法在经椎间孔入路内镜减压治疗腰椎管狭窄症中的应用  

Application of visual lateral four-quadrant three-stage facet plasty in the treatment of lumbar spinal stenosis with endoscopic decompression through intervertebral foramen approach

作　　者：陈明[1] 赵劲民[2] 程浩 廖晖[3] 赵志刚 郑勇[1] 张莹[1] 叶茂[1] 鲁力 胡洁 刘海洋 徐勇峰 李晚林 黄国最 CHEN Ming;ZHAO Jin-min;CHENG Hao;LIAO Hui;ZHAO Zhi-gang;ZHENG Yong;ZHANG Ying;YE Mao;LU Li;HU Jie;LIU Hai-yang;XU Yong-feng;LI Wan-lin;HUANG Guo-zui(Heji Orthopaedics Hospital of Xianning,Hubei University of Science and Technology Clinic Institute,Xianning 437100,China;Departments of Orthopaedics,The First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China;Department of Orthopaedics,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;The Wuhan Orthopaedics Hospital,Wuhan 430024,China)

机构地区：[1]湖北咸宁和济骨科医院/湖北科技学院临床学院,湖北咸宁437100 [2]广西医科大学第一附属医院骨科,南宁530021 [3]华中科技大学同济医学院附属同济医院骨科,武汉430030 [4]武汉市骨科医院,武汉430024

出　　处：《骨科》2020年第4期304-310,共7页ORTHOPAEDICS

摘　　要：目的探讨可视化四象限三级关节突成形法(lateral four quadrants three grade facet joint plasty, LQTP)在经椎间孔入路内镜减压治疗腰椎管狭窄症中的应用。方法前瞻性纳入2018年3月至2019年3月拟行经皮内镜下椎管减压术的55例病人,计算机随机分为两组,28例采用可视化LQTP技术作关节突成形,纳入LQTP组;27例采用标准TESSYS(transforaminal endoscopic spine system)技术行环锯椎间孔成形,纳入TESSYS组。按计划随访,并行影像学检查;比较两组病人的术中透视次数、出血量、手术时间、住院时间;比较两组术后1个月、3个月、末次随访时测定的疼痛视觉模拟量表(visual analogue scale, VAS)评分、Oswestry功能障碍指数(Oswestry disability index, ODI)及术后并发症发生情况;末次随访时以改良MacNab标准评估临床疗效。结果 LQTP组和TESSYS组的随访时间分别为(11.8±2.6)个月、(12.5±3.5)个月。两组均无椎间盘炎、血肿形成、切口及椎间隙感染、神经根损伤等严重并发症。LQTP组的透视次数、手术时间明显少于TESSYS组,两组比较,差异均有统计学意义(P均<0.05);两组术后1个月、术后3个月和末次随访时的腰腿痛VAS和ODI均较术前显著改善,与术前相比,差异均有统计学意义(P均<0.05);但两组间同时间点的指标比较,差异均无统计学意义(P均>0.05)。末次随访时,根据改良MacNab标准,LQTP组优26例,可2例,优良率为92.86%(26/28);TESSYS组优16例,良6例,可5例,优良率为81.48%(22/27);两组优良率比较,差异有统计学意义(χ~2=54.321,P<0.001)。结论可视化侧路LQTP技术配合椎管内减压治疗腰椎管狭窄症安全、有效,与经典TESSYS技术比较,具有操作简化、切骨准确、手术时间短、放射暴露少的优点。Objective To explore the application of visual lateral four quadrants three grade facet joint plasty(LQTP) in the treatment of lumbar spinal stenosis with endoscopic decompression through intervertebral foramina. Methods From March 2018 to March 2019, 55 patients who underwent percutaneous endoscopic spinal decompression were collected prospectively. The patients were randomly divided into two groups by computer. Twenty-eight patients undergoing visual LQTP technology for arthroplasty were included in the LQTP group;27 patients subject to standard transforaminal endoscopic spine system(TESSYS) technology to perform circular saw intervertebral foraminoplasty were included in the TESSYS group. The patients were followed up as planned, given imaging examination. The fluoroscopy times, bleeding volume, operation time,and hospitalization time between the two groups were compared. The pain visual analogue scale(VAS) score,Oswestry disability index(ODI) and postoperative complications measured at 1 st month, 3 rd month, and the last follow-up between the two groups were compared. At the last follow-up, the clinical efficacy was evaluated by the modified MacNab standard. Results The follow-up time in LQTP group and TESSYS group was(11.8±2.6)months and(12.5±3.5) months respectively. There were no severe complications such as intervertebral disc inflammation, hematoma formation, incision and intervertebral space infection, and nerve root injury in both groups. The frequency of fluoroscopy and operation time in the LQTP group were significantly reduced as compared with those in the TESSYS group(P<0.05). The VAS scores and ODI of lumbar and leg pain at 1 st month, 3 rd month and the last follow-up in the two groups were significantly improved as compared with those before the operation, and(P<0.05), but there was no significant difference in the index comparison between the two groups at the same time(all P>0.05). At the last follow-up, according to the modified MacNab criteria, the LQTP group was excellent in 26 cases, fa

关 键 词：腰椎 椎管狭窄 可视化 4象限 3级椎间孔成型 

分 类 号：R687.3[医药卫生—骨科学]