椎间孔镜侧入路全内镜技术治疗腰椎椎体后缘离断症的临床疗效  

Clinical effect of percutaneous transforaminal endoscopic decompression with full spinal endoscopic technique(FULL SEE)via lateral approach for the treatment of lumbar posterior edge separation of the vertebral body

作　　者：李利军[1] 师博 宋洁富[1] Li Lijun;Shi Bo;Song Jiefu(Department of Orthopedics,Shanxi Provincial People's Hospital,Taiyuan City,Shanxi Province 030012,China)

机构地区：[1]山西省人民医院骨科,太原市030012

出　　处：《中华疼痛学杂志》2020年第4期258-264,共7页Chinese Journal Of Painology

基　　金：山西省重点研发计划(一般)社会发展项目(201703D321012-1)。

摘　　要：目的初步分析经椎间孔镜侧方入路全内镜技术(FULL SEE)治疗腰椎椎体后缘离断症的临床疗效。方法收集2013年5月至2018年4月在山西省人民医院骨科行椎间孔镜侧方入路治疗腰椎椎体后缘离断症患者21例,性别不限,年龄≥18岁,均采用椎间孔入路行FULL SEE技术治疗。记录平均手术时间,并采用疼痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)于术前和术后3、6个月时对患者症状及功能进行评估。术后6个月时采用MacNab评分对总体临床疗效进行评估。结果本研究完全摘除离断骨块和突出椎间盘组织16例,不完全摘除离断骨块5例,其中1例患者术中出现硬膜损伤,全组患者均未见严重并发症。平均手术时间(78±27)min。术前VAS为(53±6)分,ODI为(41.5±8.6)分;术后3个月时VAS为(15±8)分,ODI为(13.9±7.0)分;术后6个月时VAS为(9±4)分,ODI为(9.9±5.6)分;术后3个月及6个月时VAS和ODI同术前比较均有明显改善(P均<0.05)。根据改良的MacNab疗效评定标准,术后6个月时优效14例(66.7%),良效5例(23.8%),可效2例(9.5%);手术后优良率为90.5%(19/21例)。结论对于腰椎椎体后缘离断症的患者,在严格掌握适应证及熟练操作的前提下,应用全内镜操作实行椎间孔镜侧方入路手术治疗,术后症状改善明显,可获得较高的优良率。Objective To evaluate the clinical effect of percutaneous transforaminal endoscopic decompression with full spinal endoscopic technique(FULL SEE)via lateral approach for the treatment of lumbar posterior edge separation of the vertebral body.Methods Twenty-one patients with lumbar posterior edge separation of the vertebral body,both sexes,aged≥18 years old,treated in Department of Orthopaedics,Shanxi Provincial People's Hospital,from May 2013 to April 2018,were collected in this study.All patients were treated by endoscopic transforaminal decompression(FULL SEE technology)via lateral approach.Operation time was recorded.Patient's symptoms and functional recovery were evaluated by visual analogue scale(VAS)and Oswestry disability index(ODI)at 3 and 6 months after the operation.The overall clinical efficacy was evaluated by the MacNab index at 6 months after the operation.Results The separated bone pieces and herniated disc tissue were completely removed in 16 patients,partly removed in 5 patients.Dural injury happened in one patient.No other serious complications were found.Average operation time was(78±27)min.VAS was(53±6)and ODI was(41.5±8.6)before the operation;VAS was(15±8)and ODI was(13.9±7.0)at 3 months after the operation;VAS was(9±4)and ODI was(9.9±5.6)at 6 months after the operation.VAS and ODI were significantly improved compared with pre-operation,with statistical significance(all P<0.05).The excellent effect was in 14 patients(66.7%),good effect in 5 patients(23.8%),poor effect in 2 patients(9.5%);excellent and good rate was 90.5%(19/21cases)according to the MacNab at 6 months after the operation.Conclusion Endoscopic transforaminal decompression with full spinal endoscopic technique via lateral approach could achieve good clinical results for the treatment of lumbar PRAS with strict indications.

关 键 词：腰椎 椎间盘移位 内镜 椎体后缘离断 

分 类 号：R687.3[医药卫生—骨科学]