椎间孔镜下神经根腹侧和背侧联合减压治疗高龄退变性腰椎滑脱伴神经根管狭窄症:2年以上随访报告  

Combined Ventral and Dorsal Decompression of Nerve Roots Under Transforaminal Endoscopy for Treatment of Degenerative Lumbar Spondylolisthesis With Foraminal Stenosis in the Elderly

作　　者：李新锋[1] 王琨[1,2] 靳林煜 Li Xinfeng;Wang Kun;Jin Linyu(Department of Orthopaedics, Baoshan Branch of Renji Hospital, School of Medicine, Shanghai Jiaotong University, 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12期1077-1082,共6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：目的探讨椎间孔镜下部分去除滑脱下方椎体后上缘骨质进行神经根腹侧减压联合背侧减压,治疗高龄退变性腰椎滑脱伴神经根管狭窄症的临床疗效。方法局部下经椎间孔入路,椎间孔镜下去除滑脱下方椎体后上缘骨质进行腹侧减压,同时结合去除部分肥厚黄韧带和增生关节突关节完成神经根背侧减压。采用腿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)评估术后症状改善情况,采用改良MacNab标准进行疗效评估,通过CT和(或)MRI进行术后神经减压的影像学评估,滑脱率评估腰椎滑脱程度。结果术前和术后3个月、术后2年ODI和腿痛VAS评分分别为(6.4±1.2)%、(1.7±1.0)%、(1.7±0.8)%和(68.6±6.7)、(29.6±4.9)、(30.9±5.0)分,术后均显著改善(P<0.05)。未出现永久性神经并发症。术后2年改良MacNab标准优良率为85.7%(18/21)。术前和术后2年腰椎滑脱率差异无显著性[(18.0±5.1)%vs.(18.5±5.1)%,t=-0.523,P=0.607]。术后CT和(或)MRI显示滑脱椎体下位椎体后上缘向椎管内突出的台阶样压迫被去除,神经根腹侧和背侧减压满意。结论局麻椎间孔镜下部分去除滑脱下方椎体后上缘骨质进行神经根腹侧减压,能减少背侧减压对小关节的破坏,安全可行,为部分腰椎滑脱合并神经根管狭窄症的高龄患者提供一种可供选择的治疗方法。Objective To explore the clinical effect of the treatment of ventral combined with dorsal decompression after partial removal of the bone of the posterior upper edge of the vertebral body below the spondylolisthesis for degenerative lumbar spondylolisthesis with foraminal stenosis in the elderly.Methods In this study,the elderly patients with degenerative lumbar spondylolisthesis with foraminal stenosis were selected.Under local anesthesia,endoscopic ventral decompression by partially removing posterosuperior margin underneath the slipping vertebral body,combined with dorsal decompression by removing the hypertrophic ligamentum flavum and part of the facet joint was performed to complete the decompression of the nerve root.Improvement of clinical outcome was evaluated by the Visual Analog Scale(VAS)and the Oswestry Disability Index(ODI).The surgical effect was mainly evaluated by the modified MacNab criteria.CT and/or MRI were used to evaluate the neurodecompression.Progression of lumbar spondylolisthesis was compared by measuring the rate of spondylolisthesis.Results The ODI and VAS scores of leg pain before operation,3 months after operation and 2 years after operation were(6.4±1.2)%,(1.7±1.0)%,(1.7±0.8)%,and(68.6±6.7),(29.6±4.9)and(30.9±5.0)points,respectively.The ODI and VAS scores of leg pain were significantly improved at 3 months and 2 years follow-ups(P<0.05).There was no permanent neurologic complication.The outcomes of the modified MacNab criteria showed that 85.7%(18/21)of patients obtained good-to-excellent results at 2 years after operation.There were no statistically significant differences between the percent slip of spondylolisthesis before surgery and at the end of follow-ups[(18.0±5.1)%vs.(18.5±5.1)%,t=-0.523,P=0.607].After operation,CT and/or MRI showed that the step like compression protruding to the vertebral canal was removed,and the decompression of the ventral and dorsal sides of the nerve root was satisfactory.ConclusionsIt is safe and feasible for endoscopic ventral decompression

关 键 词：退变性腰椎滑脱 神经根管狭窄 椎间孔镜 减压 

分 类 号：R68[医药卫生—骨科学]