内镜下椎弓根螺钉置入结合双通道内镜下椎间融合、减压治疗腰椎管狭窄并腰椎滑脱、不稳的早期临床效果  

Preliminary results of biportal endoscopic lumbar interbody fusion,decompression and pedicle screw insertion assisted with endoscopic technique for lumbar spinal stenosis combined with spondylolisthesis or instability

作　　者：余可谊[1] 孙权 仉建国[1] 边焱焱[1] 司春明[2] Yu Keyi;Sun Quan;Zhang Jianguo;Bian Yanyan;Si Chunming(Department of Orthopedics,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;Department of Orthopedics,Xinjiang Production and Construction Corps Hospital,Urumqi 830092,China)

机构地区：[1]中国医学科学院北京协和医院骨科,北京100730 [2]新疆生产建设兵团医院骨科,乌鲁木齐830092

出　　处：《中华医学杂志》2022年第41期3288-3294,共7页National Medical Journal of China

基　　金：国家重点研发计划(2019YFC012400);北京协和医院杰出青年基金(JQ201706)。

摘　　要：目的观察双通道内镜下腰椎椎间融合(BE-LIF)、椎管减压和内镜下椎弓根螺钉置入治疗腰椎管狭窄症并腰椎滑脱、不稳的早期临床疗效。方法回顾性分析2022年3月1日至4月30日新疆生产建设兵团医院应用BE-LIF+内镜下置钉治疗的9例单节段腰椎管狭窄并腰椎滑脱、不稳患者的临床资料。统计所有患者术前与术后3 d及末次随访时的腰腿痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI),记录手术时间、置钉时透视次数、手术出血量、术后引流量、术后下地时间,术后通过CT扫描评估椎弓根螺钉位置。结果均为女性患者,年龄(70.3±8.4)岁(56~84岁);随访12~16周。9例患者术后均获得了良好的效果。患者腰痛VAS在术后3 d及末次随访时均较术前降低[(2.9±0.6)、(1.8±0.4)比(6.4±1.1)分,均P<0.05];患者腿痛VAS在术后3 d及末次随访时均较术前降低[(1.9±0.3)、(1.4±0.5)比(7.3±1.6)分,均P<0.05],患者术后末次随访ODI较术前降低(24.0%±6.5%比55.7%±12.8%,P<0.05)。患者术中出血量为(177±103)ml,术后引流量为(122±56)ml。手术时间为(207.8±32.7)min,术后下地时间为(2.3±0.5)d。置钉时透视次数为20~42次,每颗螺钉透视(6.9±1.5)次。所有患者术中均未更改手术方式,无神经根损伤、硬脊膜损伤病例,术后均未出现严重并发症,均未行二次手术。结论内镜下置入椎弓根螺钉具有很好的可行性,术中透视次数少,安全性较高。BE-LIF技术结合椎管减压对腰椎管狭窄并腰椎滑脱、不稳早期效果确切。Objectives To evaluate the preliminary clinical outcomes of biportal endoscopic lumbar interbody fusion(BE-LIF),decompression and pedicle screw insertion assisted with endoscopic technique for lumbar spinal stenosis combined with spondylolisthesis or instability.Methods The data of 9 patients with single-level lumbar spinal stenosis who underwent BE-LIF,decompression and pedicle screw insertion assisted with biportal endoscopy in Xinjiang Production and Construction Corps Hospital from March 1st 2022 to April 30th 2022 were analyzed retrospectively.The visual analogue scales(VAS)for pain in back and legs,and the Oswestry disability index(ODI)of all the patients were collected before operation,on the third day after operation and at the last follow-up.Moreover,the operation time,intra-operation blood loss,radiation shots for pedicle screw insertion,post-operation drainage and ambulation time were recorded.The screw position was checked with CT after the operation.Results All the patients were female with a mean age of(70.3±8.4)years(ranged 56-84 years);the patients were followed-up for 12-16 weeks.All 9 patients had good clinical results.The VAS scores for back pain on the third day after operation and at the last follow-up were both significantly lower than that preoperatively[(2.9±0.6),(1.8±0.4)vs(6.4±1.1)points,both P<0.05].The VAS scores for leg pain on the third day after operation and at the last follow-up were both significantly lower than that preoperatively[(1.9±0.3),(1.4±0.5)vs(7.3±1.6)points,P<0.05].The ODI scores at last follow-up was significantly lower than that before the operation(24.0%±6.5%vs 55.7%±12.8%,P<0.05).The intra-operative blood loss was(177±103)ml,the drainage amounts post-operation was(122±56)ml,the operation time was(207.8±32.7)min,the ambulation time was(2.3±0.5)days.The total radiation shots for pedicle screw insertion were 20-42 times,the average radiation shots per screw was(6.9±1.5)times.No severe complications or adverse events occurred.No nerve root injury or dural

关 键 词：椎管狭窄 腰椎管狭窄症 双通道内镜 椎弓根螺钉 椎间融合 早期疗效 

分 类 号：R687.3[医药卫生—骨科学]