经皮椎间孔入路脊柱内镜下应用骨凿技术减压治疗老年单侧腰椎侧隐窝狭窄的疗效  

PEID with bone-chisel technique in the treatment of unilateral lumber lateral recess stenosis: A curative effect study in elderly patients

作　　者：王贺 谢昌达 王辰超 李展奇 WANG He;XIE Changda;WANG Chenchao;LI Zhanqi(Xi’an People’s Hospital/Xi’an Fourth Hospital,Xi’an 710004,China)

机构地区：[1]西安市人民医院/西安市第四医院,陕西西安710004

出　　处：《西安交通大学学报（医学版）》2021年第6期813-816,共4页Journal of Xi’an Jiaotong University（Medical Sciences）

摘　　要：目的观察经皮椎间孔入路脊柱内镜下应用骨凿技术减压治疗老年单侧腰椎侧隐窝狭窄的疗效。方法选取本院2017年3月-2019年7月年龄>60岁且因单侧腰椎侧隐窝狭窄症接受经皮椎间孔入路脊柱内镜手术的患者46例,收集患者术前、术后的VAS评分、ODI指数及改良MacNab疗效等指标评估疼痛、腰椎功能及患者满意度,比较术前、术后CT侧隐窝矢状径评估侧隐窝减压情况。随访至少1年并观察并发症情况。结果 46例患者均接受随访,随访时间17~42个月,1例出现硬脊膜撕裂,2例出现一过性神经根刺激症状,无其他并发症。所有患者末次随访的腰痛VAS评分、下肢痛VAS评分及ODI指数较术前明显改善(P<0.05)。末次随访时改良MacNab疗效评估结果显示,优良率91.3%(优38、良4、可4)。骨性侧隐窝矢状径(mm)术后1年较术前显著改善(4.22±1.25 vs. 2.71±0.57,t=6.354,P<0.001)。矢状径平均增加55.8%。结论经皮椎间孔入路脊柱内镜下应用骨凿技术减压治疗老年单侧侧隐窝狭窄可获得良好临床疗效。Objective To investigate the effect of decompression technique with bone-chisel under percutaneous spinal endoscopy through transforaminal approach in elderly patients with unilateral lateral recess stenosis(ULLRS).Methods We enrolled 46 old patients with ULLRS who underwent percutaneous spinal endoscopy through transforaminal approach assisted with bone-chisel technique from March 2017 to July 2019. The visual analogue scale(VAS)score of low back pain and leg pain, the Oswestry dysfunction index(ODI), and the modified MacNab score before and after operation were obtained. We also recorded preoperative and postoperative sagittal diameter measured by computer tomography(CT)to evaluate decompression of the lateral recess. All the patients were followed up for at least 1 year for complications. Results All the 46 patients were followed up for 17 to 42 months. Dural tear occurred in one case,transient nerve root irritation in two cases, and there were no other complications. The low back pain VAS score, lower limb pain VAS score,and ODI index of all the patients were significantly improved in the last follow-up(P<0. 05). The results of the modified MacNab efficacy evaluation at the last follow-up revealed that the excellent and good rate was 91. 3%(excellent in 38, good in 4, and fair in 4). The sagittal diameter(mm)of the bony lateral recess 1 year after surgery increased by an average of 55. 8%, which was significantly better than that before surgery(t=6. 354, 4. 22±1. 25 vs. 2. 71±0. 57, P<0. 001). Conclusion Percutaneous spinal endoscopy through transforaminal foramen approach combined with bone-chisel technique is effective in treating ULLRS in elderly patients.

关 键 词：侧隐窝狭窄症 椎间孔入路 骨凿技术 经皮脊柱内镜 老年患者 

分 类 号：R681.5[医药卫生—骨科学]