经皮椎间孔入路脊柱内镜下减压治疗高龄腰椎滑脱21例  

21 Cases of Experience of Percutaneous Spinal Endoscopy in the Treatment of Senile Spondylolisthesis with Root Pain

作　　者：范有福[1] 王想福[1] 叶丙霖[1] 孙凤歧[1] 陈伟国 张万乾 FAN Youfu;WANG Xiangfu;YE Binglin;SUN Fengqi;CHEN Weiguo;ZHANG Wanqian(Gansu Provincial Hospital of Traditional Chinese Medicine,Lanzhou 730050,China;Gansu University of Traditional Chinese Medicine,Lanzhou 730000,China)

机构地区：[1]甘肃省中医院,兰州730050 [2]甘肃中医药大学

出　　处：《中国中医骨伤科杂志》2021年第9期46-49,共4页Chinese Journal of Traditional Medical Traumatology & Orthopedics

基　　金：兰州市人才创新创业项目(2020-RC-54)。

摘　　要：目的:探讨经椎间孔入路全脊柱内镜下上关节突成形、侧隐窝上部分减压,治疗高龄退变性腰椎滑脱的临床疗效。方法:局麻下经皮脊柱内镜经椎间孔入路行出口、行走神经根减压治疗。采用VAS、ODI评分及改良MacNab对其进行临床疗效评价。结果:本组21例患者随访6~24个月,平均随访10.5个月,平均手术时间为(56.5±8.6)min。术后患者下肢根性疼痛、根性损害表现较术前均有不同程度的改善。VAS评分术前为(7.36±1.28)分,术后3个月为(3.25±1.22)分,术后6个月为(1.25±0.33)分,术后12个月为(0.76±0.43)分。ODI评分术前为(49.8±6.5)%,术后3个月为(32.6±10.8)%,术后6个月为(20.1±5.5)%,术后12个月为(10.2±5.4)%。VAS与ODI评分差异有统计学意义(P<0.05)。末次随访采用改良MacNab评价优良率达91.2%。结论:局麻下经皮椎间孔入路内镜下神经根减压术疗效显著,无明显并发症,安全性高,疗效确定,为部分不能耐受开放手术的高龄退行性腰椎滑脱患者提供了一种安全有效的治疗方法。Objective:To investigate the clinical effect of transforaminal approach to the treatment for degenerative lumbar spondylolisthesis with radicular pain under the upper articular process and decompression of the upper part of the lateral recess under total spine endoscope.Methods:Percutaneous spinal endoscopy under local anesthesia through the intervertebral foramina approach was adopted to decompress of the exit nerve root and walking nerve root.VAS,ODI score,and modified MacNab were used to evaluate its clinical efficacy.Results:The 21patients in this group were followed up for 6to 24months,with an average follow-up time of 10.5months.The average operation time was(56.5±8.6)min.The postoperative lower extremity radicular pain and radicular damage were improved to varying degrees compared with the preoperative performance.The VAS score was(7.36±1.28)points before operation,(3.25±1.22)points after 3months,(1.25±0.33)points after 6months,and(0.76±0.43)points after 12months.The ODI score was(49.8±6.5)%points before operation,(32.6±10.8)%points after 3months,(20.1±5.5)%points after 6months,and(10.2±5.4)%points after 12months.The difference between VAS score and ODI score was statistically significant(P<0.05).At the last follow-up,the improved MacNab was used to evaluate the excellent and good rate of 91.2%.Conclusion:Percutaneous endoscopic foraminal nerve root decompression under local anesthesia has significant curative effect,without obvious complications,and high safety.It is provided for some elderly patients with degenerative lumbar spondylolisthesis and radicular pain who cannot tolerate open surgery.It is a safe and effective treatment method.

关 键 词：高龄 腰椎滑脱 经皮脊柱内镜 椎间孔镜 

分 类 号：R681.5[医药卫生—骨科学]