经皮脊柱内镜盘外减压技术在老年退变性腰椎滑脱中的临床应用及短期疗效  

Clinical application and short-term efficacy of percutaneous endoscopic transforaminal outside-disc decompression in elderly degenerative lumbar spondylolisthesis

作　　者：冯品[1] 晏玉清 张斌[1] 刘俊麟 胡源 孔清泉[2] FENG Pin;YAN Yu-qing;ZHANG Bin;LIU Jun-lin;HU Yuan;KONG Qing-quan(Department of Orthopedics,Tibetan Chengdu Office Branch Hospital of West China Hospital,Sichuan University,Chengdu,Sichuan,610041,China)

机构地区：[1]四川大学华西医院西藏成办分院骨科,成都610041 [2]四川大学华西医院骨科,成都610041

出　　处：《中国骨与关节杂志》2021年第10期766-770,共5页Chinese Journal of Bone and Joint

基　　金：西藏自治区科技计划项目(XZ201901-GB-08)。

摘　　要：目的总结经皮脊柱内镜盘外减压技术治疗老年退变性腰椎滑脱症(degenerative lumbar spondylolisthesis,DLS)的临床应用及短期随访效果。方法回顾性分析2017年10月至2019年3月,我院采用经皮脊柱内镜盘外减压技术治疗的27例DLS患者,其中男11例,女16例,平均(72.2±5.4)岁,所有病例均为Ⅰ度以内的退变性滑脱,均以神经根性疼痛为主而腰部疼痛不明显,腰部疼痛视觉模拟评分(visual analogue scale,VAS)<3分,影像学提示无明显节段不稳。所有病例均行经椎间孔入路的经皮脊柱内镜盘外减压技术,减压范围主要为神经根背侧、椎间盘中下部及椎体上缘下3~5 mm处。术前、术后采用VAS评分和Oswestry功能障碍指数(oswestry disability index,ODI)、末次随访根据改良MacNab标准评估手术疗效。结果27例均顺利实施手术,无神经损伤、椎间隙感染及中转开放手术。术后随访时间14~24个月,平均(18.1±2.7)个月。患者术前、术后3个月、术后12个月、末次随访VAS评分分别为(6.1±0.8)分,(2.4±0.6)分,(1.4±0.5)分,(0.7±0.6)分,ODI分别为(65.1±6.7)分,(19.4±4.1)分,(7.8±2.2)分,(5.3±1.4)分,不同随访时间点评估结果同术前相比差异有统计学意义(P<0.05),疼痛及生活能力显著改善。末次随访,根据MacNab疗效评定标准,优22例,良4例,可1例,优良率96.3%。术后3个月、12个月及末次随访MRI检查示椎间盘无明显突出,末次随访复查腰椎过伸过屈位X线均无不稳及滑脱加重。结论经皮脊柱内镜盘外减压技术治疗老年DLS,具有手术创伤小、出血少、术后功能恢复快等特点,是一种微创、有效的方法,其短期临床效果满意,但须严格把握手术适应证、手术入路及减压范围。Objective To present the clinical application and short-term follow-up results of percutaneous endoscopic transforaminal outside-disc decompression technique in the treatment of elderly degenerative lumbar spondylolisthesis(DLS).Methods A cohort of 27 DLS cases after percutaneous endoscopic transforaminal outside-disc decompression were included between October 2017 and March 2019.There were 11 males and 16 females with an average age of(72.2±5.4)years.Degenerative spondylolisthesis withinⅠ,severe radicular leg pain,mild waist pain,waist visual analogue scale(VAS)<3 and no significant segmental instability were noted in all cases.The decompression area was mainly focused on the dorsal side of the nerve root,the middle and lower part of the disc and 3-5mm below the upper edge of the vertebral body.VAS and ODI preoperatively and postoperatively,MacNab at the final follow-up were recorded to assess efficacy.Results All operations were finished successfully without nerve injury,intervertebral space infection,or transition to open surgery.The mean follow-up was(18.1±2.7)months(range:14-24 months).VAS and ODI preoperatively,3 months postoperatively,12 months postoperatively,at the last follow-up:(6.1±0.8),(2.4±0.6),(1.4±0.5),(0.7±0.6);(65.1±6.7),(19.4±4.1),(7.8±2.2),(5.3±1.4).Significant differences were observed postoperatively compared with the preoperative data,as well as leg pain improvement and living ability(P<0.05).MacNab at the final follow-up:excellent in 22 cases,good in4 cases,fair in 1 case,excellent and good rate 96.3%.MRI at 3rd month,12th month,and the last follow-up showed no significant disc herniation.At the last follow-up,the lumbar hyperextension and flexion X-ray image showed no lumbar instability or spondylolisthesis exacerbation.Conclusions Percutaneous endoscopic transforaminal outside-disc decompression,being minimally invasive and effective,brings less trauma and bleeding in the treatment of elderly degenerative lumbar spondylolisthesis,which facilitates faster postoperative functi

关 键 词：最小侵入性外科手术 脊椎滑脱 腰椎 减压术 外科 

分 类 号：R681.5[医药卫生—骨科学]