对侧入路在经皮微创通道减压术治疗小椎板退变型侧方腰椎椎管狭窄中的应用  

Application of minimally invasive percutaneous decompression via contralateral approach in the treatment of lateral lumbar spinal stenosis with degeneration of small lamina

作　　者：疏龙飞 代飞虎 张晨旭 郑杰 唐忠宇 张亮 王玉海 赵伟 Shu Longfei;Dai Feihu;Zhang Chenxu;Zheng Jie;Tang Zhongyu;Zhang Liang;Wang Yuhai;Zhao Wei(Hospital of PLA Joint Logistic Support Force,Wuxi 214044,China)

机构地区：[1]解放军联勤保障部队第九〇四医院神经外科,无锡214044

出　　处：《中华神经外科杂志》2023年第3期255-260,共6页Chinese Journal of Neurosurgery

基　　金：联勤保障部队第九〇四医院院内基金(MS202116)。

摘　　要：目的探讨对侧入路在经皮微创通道减压术治疗小椎板退变型侧方腰椎椎管狭窄中的应用价值。方法回顾性分析2019年9月至2020年12月解放军联勤保障部队第九〇四医院神经外科采用显微镜经皮微创通道对侧椎旁入路减压术治疗的15例小椎板退变型侧方腰椎椎管狭窄症患者的临床资料。比较CT上病变节段椎弓根上切迹切面术后椎板开窗宽度与棘突根部至关节突背侧关节面的距离,并评估术后双侧关节突关节面的磨除情况;观察MRI上术后硬膜囊横径、矢状径较术前的变化情况。术后定期行临床随访,评估疼痛视觉模拟量表(VAS)评分、日本骨科学会(JOA)评分和Oswestry功能障碍指数(ODI)较术前的改善情况。通过影像学随访评估腰椎的稳定性。结果15例患者均未发生与手术相关的神经损伤、脑脊液漏及颅内感染。手术时间为(74.9±13.6)min(60~100 min),术中出血量为(25.9±10.1)ml(15~50 ml)。术后CT显示症状对侧椎板开窗宽度为(9.0±1.2)mm,小于棘突根部至背侧关节面的距离[(13.1±1.2)mm](P<0.05);术后症状侧关节面的剩余宽度[(16.8±1.8)mm]大于术前关节面宽度的2/3[(12.4±1.3)mm],对侧关节面的剩余宽度[(15.6±1.7)mm]亦大于术前关节面宽度的2/3[(12.5±1.2)mm](均P<0.001)。硬膜囊的横径由术前的(7.8±1.5)mm增大至(14.9±1.2)mm,矢状径由术前的(9.2±1.8)mm增大至(14.8±2.1)mm,差异均有统计学意义(均P<0.001)。15例患者均获得随访,随访时间为(8.1±2.3)个月(6~12个月)。至末次随访,VAS评分由术前的(5.3±1.5)分下降至(0.6±0.2)分,JOA评分由术前的(14.5±1.8)分恢复至(26.7±5.3)分,ODI由术前的69.5%±13.8%减少至12.9%±2.1%,差异均有统计学意义(均P<0.05)。术后X线片检查未见腰椎失稳症或侧弯畸形。结论显微镜经皮微创通道对侧椎旁入路减压术治疗小椎板退变型侧方腰椎椎管狭窄症的疗效确切,减压充分,同时能够最大程度保护双侧的�Objective To explore the application value of minimally invasive percutaneous decompression via contralateral approach in the treatment of lateral lumbar spinal stenosis with degeneration of small lamina.Methods A retrospective analysis was conducted on the clinical data of 15 patients with lateral lumbar spinal stenosis with degeneration of small lamina who underwent minimally invasive percutaneous decompression via contralateral approach at the Department of Neurosurgery,the 904th Hospital of PLA Joint Logistic Support Force from September 2019 to December 2020.We compared the width of lamina fenestration post operation with the distance from the root of spinous process to the dorsal articular surface prior to operation in the suprapedicle notch section CT,and evaluated the abrasion of bilateral facet joints after operation.The change of transverse and sagittal diameters of dural sac based on MRI results were analyzed.Regular clinical follow-up was performed after operation.The improvement of visual analogue scale(VAS)score,Japanese orthopedic association(JOA)score and Oswestry dysfunction index(ODI)post operation were evaluated based on the comparison with their pre-operative values.The stability of lumbar spine was determined by imaging follow-up.Results All 15 patients successfully underwent the operation.There was no case of nerve injury,cerebrospinal fluid leakage or post-operative infection.The operation time was 74.9±13.6 min(60-100 min),the volume of intraoperative blood loss was 25.9±10.1 ml(15-50 ml).Post-operative CT showed that the width of contralateral lamina fenestration was 9.0±1.2 mm,which was less than the distance from the root of spinous process to the dorsal articular surface(13.1±1.2 mm)(P<0.05).The residual width of ipsilateral articular surface(16.8±1.8 mm)and contralateral articular surface(15.6±1.7 mm)were greater than 2/3 of the pre-operative articular surface width(ipsilateral:12.4±1.3 mm,contralateral:12.5±1.2 mm)(both P<0.001).Post-operative MRI showed that the transverse d

关 键 词：腰椎 椎管狭窄 显微外科手术 微通道 对侧入路 

分 类 号：R726.8[医药卫生—儿科]