单边双通道内镜技术治疗腰椎间盘突出症和腰椎椎管狭窄症  

Unilateral biportal endoscopic technique for lumbar disc herniation and lumbar spinal stenosis

作　　者：田大胜[1] 刘建军 朱斌[1] 陈磊[1] 王其飞 钟华璋 孙一松 王义国 荆珏华[1] Tian Dasheng;Liu Jianjun;Zhu Bin;Chen Lei;Wang Qifei;Zhong Huazhang;Sun Yisong;Wang Yiguo;Jing Juehua(Department of Orthopaedics,the Second Hospital of Anhui Medical University,Hefei 230601,China)

机构地区：[1]安徽医科大学第二附属医院骨科,合肥230601

出　　处：《中华骨科杂志》2020年第17期1155-1164,共10页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(61872407)。

摘　　要：目的探讨单边双通道内镜技术治疗腰椎间盘突出症和腰椎椎管狭窄症的临床疗效。方法2018年7月至2019年6月采用单边双通道内镜技术治疗腰椎间盘突出症和腰椎椎管狭窄症患者60例,依据纳入和排除标准,51例患者纳入研究。脱出型腰椎间盘突出症25例,腰椎椎管狭窄症26例,均采用单边双通道内镜辅助下后路单侧椎板开窗椎管减压术,其中双侧狭窄者经单侧入路潜行减压至对侧;5例伴失稳者同时行内镜下椎体间融合及经皮椎弓根螺钉内固定术。记录手术时间、术后住院时间、切口长度以及并发症情况,根据术前、术后1、3、6个月及末次随访时腰痛和下肢痛的疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)及改良Macnab评分评估临床疗效。结果所有患者手术均顺利完成,无术中转为开放手术的病例。镜下手术时间(70.29±19.55)min(范围:44~151 min);总切口长度为(1.79±0.34)cm(范围:1.4~3.0 cm)。术后CT示减压充分,对侧椎板、关节突保留完整。所有患者术后1~3 d下床活动,术后住院时间为(3.49±2.76)d(范围:1~14 d)。术后随访时间为(13.59±2.80)个月(范围:10~21个月)。46例患者术后3周内恢复正常生活,5例行椎体间融合的患者术后4周恢复正常生活。26例腰椎椎管狭症患者腰痛VAS评分由术前(6.69±1.44)分,降低至术后1个月(3.27±1.43)分、3个月(2.69±1.57)分、6个月(2.31±1.16)和末次随访时(2.23±1.28)分;下肢痛VAS评分由术前(6.77±1.34)分,降低至术后1个月(3.27±1.37)分、3个月(2.88±1.48)分、6个月(2.85±1.52)分和末次随访时(2.54±1.53)分;ODI由术前64.18%±8.23%,降低至术后1个月37.53%±4.45%、3个月27.51%±3.83%、6个月19.91%±5.27%和末次随访时6.84%±2.74%,手术前后的差异有统计学意义(F=128.534,F=146.951,F=783.966,均P<0.005)。25例腰椎间盘突出症患者腰痛VAS评分由术前(5.60±1.38)分,降低至术后Objective To develop a unilateral biportal endoscopic technique and investigate the clinical efficacy of unilateral biportal endoscopic technique in the treatment of lumbar disc herniation and lumbar spinal stenosis.Methods Between July 2018 and June 2019,60 patients with lumbar disc herniation or spinal stenosis were treated by unilateral biportal endoscopic technique.According to the inclusion and exclusion criteria,51 patients were included in the study.There were 25 cases of prolapsed lumbar disc herniation,26 cases of degenerative lumbar spinal stenosis,all of which were treated with posterior lumbar decompression by unilateral biportal endoscopic laminectomy,and contralateral stealth decompression by unilateral approach was performed on the patients with bilateral stenosis.Endoscopic interbody fusion and percutaneous pedicle screw fixation were performed in 5 patients with instability.Operation time,length of incision,hospital stay and complications were recorded.Visual analogue scale(VAS)for low back pain and leg pain,Oswestry dysfunction index(ODI)and the modified Macnab scale were used to evaluate the clinical efficacy.Results All operations were completed successfully,and no cases were transferred to open surgery.The operative time was 70.29±19.55 min(44-151 min),while the length of incision was 1.79±0.34 cm(1.4-3.0 cm).Postoperative CT suggested complete decompression with intact contralateral structure.All patients got out of bed 1-3 d after surgery,and the postoperative hospital stay was 3.49±2.76 d(1-14 d).The postoperative follow-up time was 13.59±2.80 months(10-21 months).Forty-six patients returned to work or normal activities within 3 weeks and 5 patients with interbody fusion returned to normal activities within 4 weeks.According to the modified Macnab criteria,the final outcome was excellent in 43 cases,good in 6 cases,and fair in 2 cases.There were 3 cases of dural sac tear during operation and 2 cases of transient numbness of lower limbs after surgery and they all recovered after conserv

关 键 词：腰椎 椎间盘移位 椎管狭窄 关节镜 

分 类 号：R687.3[医药卫生—骨科学]