经皮椎间孔成形术治疗腰椎间孔狭窄症的效果与影像学参数的相关性  

Percutaneous endoscopic lumbar foraminoplasty in the treatment of patients with lumbar foraminal stenosis and its correlation with imaging parameters

作　　者：荆志振[1] 李利军[1] 崔小平[1] 宋洁富[1] 常峰[1] Jing Zhizhen;Li Lijun;Cui Xiaoping;Song Jiefu;Chang Feng(Department of Orthopaedics,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》2021年第4期373-378,共6页Chinese Journal Of Painology

摘　　要：目的探讨经皮椎间孔镜下椎间孔成形术(PELF)治疗腰椎间孔狭窄症(LFS)的临床效果并分析其与影像学参数的相关性。方法回顾性分析2016年7月至2018年10月在山西省人民医院骨科因单侧LFS行PELF术患者26例,性别不限,年龄≥18岁。所有患者均接受PELF治疗。于术前及术后3个月、末次随访(术后12~17个月)时,评估疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI),并在末次随访时采用MacNab法评定疗效。分析手术前后影像学参数(椎间盘高度指数、腰椎前凸角、椎体滑移百分率、腰椎冠状面Cobb角、椎间盘楔形角和椎间孔面积)与临床效果的相关性。结果与术前比较,术后3个月及末次随访时VAS评分、ODI评分均降低(P均<0.05)。末次随访时,有效率为96.2%(25/26例)。术前、术后腰椎前凸角与VAS评分、ODI评分呈负相关(P均<0.05),术前椎体滑移百分率与VAS评分、ODI评分呈正相关(P均<0.05)。多重线性回归分析显示术前腰椎前凸角较小,效果较差(β=-1.086,P=0.004)。结论PELF治疗LFS效果良好,术前腰椎前凸减少是影响效果的危险因素。Objective To evaluate the efficacy of percutaneous endoscopic lumbar foraminoplasty(PELF)in the treatment of patients with lumbar foraminal stenosis(LFS)and its correlation with imaging parameters.Methods Twenty-six patients with LFS underwent PELF were recruited in this retrospective study,both sexes,aged≥18 years old,from July 2016 to October 2018 in Department of Orthopaedics,Shanxi Provincial People's Hospital.All patients were received PELF for nerve root decompression.VAS,ODI were recorded before the operation,3 months and the last follow-up(12-17 months)after the operation.The clinical efficacy was evaluated by MacNab at the last follow-up.The correlations between imaging parameters and clinical efficacy were performed.Imaging parameters were examined including disc height index,lumbar lordosis,slip percentage,disc wedging angle,lumbar Cobb's angle,and sagittal area of foramen in CT scan.Results Compared with pretreatment,VAS and ODI were decreased at 3 months and the last postoperative follow-up(all P<0.05).The effective rate was 96.2%(25/26 cases)at the last follow-up.There was a negative correlation between lumbar lordosis and VAS,ODI at pre-or post-operation respectively(all P<0.05),and a positive correlation between slip percentage and VAS,ODI respectively(all P<0.05).Multiple linear regression analysis showed that preoperative lumbar lordosis was smaller and the efficacy was poorer(β=-1.086,P=0.004).Conclusion Percutaneous endoscopic lumbar foraminoplasty is effective in the treatment of patients with lumbar foraminal stenosis,and preoperative smaller of lumbar lordosis is a risk factor affecting the results.

关 键 词：腰椎骨 椎间孔切开术 椎间孔狭窄 影像学参数 

分 类 号：R687.3[医药卫生—骨科学]