经皮椎间孔入路内窥镜下减压术治疗老年腰椎管狭窄症  

Percutaneous transforaminal endoscopic decompression for elderly lumbar spinal stenosis

作　　者：宋锦程[1] 严飞[1] 王黎明[1] 沙卫平[1] 缪秀华 赵理平[1] 朱寅[1] SONG Jin-cheng;YAN Fei;WANG Li-ming;SHA Wei-ping;MIAO Xiu-hua;ZHAO LI-ping;ZHU Yin(Department of Spinal Surgery,Zhangjiagang Hospital Affiliated to Suzhou University,Suzhou,Jiangsu,215600,China)

机构地区：[1]苏州大学附属张家港医院脊柱外科,江苏苏州215600

出　　处：《颈腰痛杂志》2020年第6期641-645,共5页The Journal of Cervicodynia and Lumbodynia

基　　金：江苏省卫生厅重点学科建设开放课题(编号:WKF2017-02)。

摘　　要：目的探讨老年腰椎管狭窄症采用内窥镜经皮椎间孔入路下减压术治疗效果及安全性。方法纳入2016年1月~2018年3月行经皮椎间孔入路内窥镜下减压术治疗的70岁以上老年腰椎管狭窄症患者28例,记录手术时间、术后并发症情况。于术前、术后1、3、12个月采用下肢疼痛的VAS评分、ODI指数及改良MacNab标准评价临床疗效。结果28例患者手术时间60~140 min,平均(85±36)min;术后获随访12~24个月,平均16.5个月。腿痛VAS评分术前为(6.23±1.02)分,术后1个月为(2.82±0.54)分,术后3个月为(2.24±0.51)分,术后12个月降至(1.01±0.31)分;ODI术前为(65.38±11.12)%,术后1个月为(25.32±9.42)%,术后3个月为(15.24±7.65)%,术后12个月降至(9.82±4.53)%。术后VAS、ODI较术前显著改善(P<0.01)。改良MacNab疗效评定优良率为85.7%。结论经皮椎间孔入路内镜下减压术治疗老年腰椎管狭窄症,对患者全身影响小,手术创伤小,减压效果确切,是一种安全有效的微创手术。Objective To investigate the safety and clinical efficacy of percutaneous endoscopic decompression in the treatment of lumbar spinal stenosis in the elderly.Methods From January 2016 to March 2018,28 elderly patients with lumbar spinal stenosis who underwent percutaneous transforaminal endoscopic decompression were enrolled.The operation time and complications were recorded.VAS scale,ODI index and improved MacNab criteria were used to evaluate the clinical efficacy before surgery and 1,3 and 12 months after surgery.Results The operation time of 28 patients ranged from 60 to 140 minutes,with an average of(85±36)min.The follow-up period ranged from 12 to 24 months,with an average of 16.5 months.The VAS score of leg pain was(6.23±1.02)before operation,and the VAS scores at 1,3,12 months after operation were(2.82±0.54),(2.24±0.51)and(1.01±0.31).The ODI was(65.38±11.12)% before operation,and the ODI at 1,3,12 months after operation were(25.32±9.42)%,(15.24±7.65)% and(9.82±4.53)%.The VAS score and ODI index after operation were significantly improved compared with before operation(P<0.01).At the last follow-up,21 cases were excellent,3 cases were good,and 4 cases were fair.The excellent and good rate was 85.7%.Conclusion Percutaneous transforaminal endoscopic decompression is a safe and effective minimally invasive procedure for the treatment of senile lumbar spinal stenosis,which has less systemic impact,less surgical trauma and exact decompression effect.

关 键 词：腰椎管狭窄症 脊柱内窥镜 老年人群 椎间孔入路 

分 类 号：R681.5[医药卫生—骨科学]