单侧双通道内镜技术治疗腰椎椎体后缘离断症的临床疗效  

Clinical Effect of Unilateral Biportal Endoscopic Technique in the Treatment of Posterior Apophyseal Ring Separation

作　　者：段黄强 花奔 汤文杰 康照利 李勇[2,3] 王辉[2] 喻亮[2] 黄文星 DUAN Huangqiang;HUA Ben;TANG Wenjie;KANG Zhaoli;LI Yong;WANG Hui;YU Liang;HUANG Wenxing(Department of Spine Surgery,Postgraduate Training Base of Jinzhou Medical University(Xiaogan Central Hospital),Xiaogan 432100,China;Department of Spine Surgery,Xiaogan Hospital Affiliated to Wuhan University of Science and Technology,Xiaogan 432100,China;Department of Orthopaedics,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]锦州医科大学孝感市中心医院研究生培养基地,脊柱外科,湖北孝感432100 [2]武汉科技大学附属孝感医院脊柱外科,湖北孝感432100 [3]华中科技大学同济医学院附属同济医院骨科,武汉430030

出　　处：《骨科》2023年第4期316-320,共5页ORTHOPAEDICS

摘　　要：目的探讨单侧双通道内镜技术(unilateral biportal endoscopy,UBE)治疗腰椎椎体后缘离断症(posterior apophyseal ring separation,PARS)的临床疗效。方法回顾性分析2021年6月至2022年6月于武汉科技大学附属孝感医院脊柱外科采用UBE治疗PARS的20例病人,男11例,女9例;年龄为17~45岁,平均34.4岁。责任节段:L4/5节段12例,L5/S1节段8例。均采用症状侧入路,镜下摘除突出髓核及离断骨块。术后定期随访,采用腰腿痛视觉模拟量表(visual analogue scale,VAS)评分和Oswestry功能障碍指数(Oswestry disability index,ODI)评价疼痛程度及功能活动。术后根据改良MacNab评分评估疗效。结果所有病人均顺利完成手术且获得满意临床效果,无神经根损伤、脑脊液漏等相关并发症发生。术后MRI及CT三维成像显示20例病人突出髓核及致压骨块均摘除。病人获6~12个月随访,平均8个月,随访期间未见责任节段复发。术后1个月、6个月与末次随访的腰腿痛VAS评分和ODI指数均显著低于术前,差异均有统计学意义(P<0.05)。末次随访时,MacNab疗效评定标准满意程度:优14例,良5例,可1例,优良率为95%。结论UBE技术治疗PARS具有神经减压充分、减压效果明确以及临床疗效确切等优点,具有良好的安全性和可行性。Objective To evaluate the clinical efficacy of unilateral biportal endoscopy(UBE)in the treatment of posterior apophyseal ring separation(PARS)of the lumbar spine.Methods A total of 20 patients with PARS treated with UBE from June 2021 to June 2022 were retrospectively analyzed.There were 11 males and 9 females.Their age ranged from 17 to 45 years(mean 34.4 years).The segments involved included L4/5 level in 12 cases and L5/S1 level in 8 cases.All patients were treated through the symptomatic side approach,and the protruding nucleus pulposus and broken fragments of bone were removed under a microscope.The visual analogue scale(VAS)of low back pain and leg pain and Oswestry disability index(ODI)were used to evaluate the pain and functional activity.The effectiveness was evaluated according to the modified MacNab score after operation.Results All patients successfully completed the operation and achieved satisfactory clinical results.No nerve root injury,cerebrospinal fluid leakage,and other related complications occurred.Postoperative magnetic resonance imaging and three⁃dimensional CT imaging showed that the protruding nucleus pulposus and compression bone fragments were removed in 20 patients.The patients were followed up for 6 to 12 months,with an average of 8 months.During the follow⁃up period,no recurrence of the responsible segment was found.The VAS scores of low back pain and leg pain and ODI at 1 month,6 months and the last follow⁃up after operation were significantly lower than those before operation(P<0.05).According to the MacNab criteria,the results were excellent in 14 cases,good in 5 cases,fair in 1 case,with an excellent and good rate of 95%.Conclusion The UBE technique in the treatment of PARS has the advantages of sufficient nerve decompression,clear decompression effect,and definite clinical efficacy,with good safety and feasibility.

关 键 词：腰椎 椎体后缘离断症 腰椎间盘突出症 单侧双通道内镜技术 微创 临床观察 

分 类 号：R687.3[医药卫生—骨科学]