单侧双通道关节镜技术治疗老年退行性腰椎管狭窄症  

Unilateral biportal endoscopic technique for treatment of elderly degenerative lumbar spinal stenosis

作　　者：黄志明[1] 林晓[1] 林伟 章建卫[1] 李高舜[1] HUANG Zhi-ming;LIN Xiao;LIN Wei;ZHANG Jian-wei;LI Gao-shun(Dept of Spinal Surgery,Taizhou Integrated Traditional Chinese and Western Medicine Hospital,Wenling,Zhejiang 317523,China)

机构地区：[1]台州市中西医结合医院脊柱外科,浙江温岭317523

出　　处：《临床骨科杂志》2023年第4期491-494,共4页Journal of Clinical Orthopaedics

基　　金：浙江省卫健委中医药科技计划项目(编号:2023ZL789);浙江省温岭市科技局科技项目(编号:2019S0180036)。

摘　　要：目的 观察单侧双通道关节镜技术治疗老年退行性腰椎管狭窄症的疗效。方法 采用单侧双通道关节镜技术治疗16例老年退行性腰椎管狭窄症患者。记录手术情况,采用疼痛VAS评分和ODI评价疼痛及功能障碍情况,术后3个月应用MacNab标准评价临床疗效。结果 术后CT+三维重建均显示椎管减压充分。1例术中发生约3 mm硬脊膜损伤,1例术后当天晚上出现谵妄。患者均获得随访,时间3~12个月。疼痛VAS评分、ODI:术后1 d、1个月、3个月均较术前明显改善(P<0.05)。术后3个月采用MacNab标准评价临床疗效:优10例,良4例,可2例,优良率为14/16。末次随访时,患者腰腿痛症状和间歇性跛行症状均得到缓解,2例有轻度腰痛症状。结论 单侧双通道关节镜技术治疗老年退行性腰椎管狭窄症临床疗效满意,关节镜下手术视野开阔清晰,手术操作灵活、安全。Objective To observe the effect of unilateral biportal endoscopic technique in the treatment of elderly degenerative lumbar spinal stenosis.Methods The 16 elderly patients with degenerative lumbar spinal stenoses were treated by unilateral biportal endoscopic technique.The surgical results were recorded,pain VAS and ODI were used to evaluate the pain and dysfunction,and MacNab standard was used to evaluate the clinical effect at 3 months after the operation.Results CT+three-dimesional(3D)reconstruction showed sufficient decompression of spinal canal.One patient had intraoperative dural injury about 3 mm,and one patient had delirium in the night after surgery.All 16 patients were followed up for 3~12 months.Pain VAS and ODI:at 1 d,1,3 months after surgery,they were significantly improved than those before surgery(P<0.05).Three months after surgery,MacNab standard was used to evaluate the clinical effect:excellent 10 cases,good 4,fair 2,the excellent-good rate was 14/16.At the last follow-up,the lumbocrural pain and intermittent claudication were relieved in all patients,and 2 cases had mild symptoms of low back pain.Conclusions Unilateral biportal endoscopic technique has satisfactory clinical efficacy in the treatment of elderly degenerative lumbar spinal stenosis.The surgical field of vision under endoscopy is clear,and the operation is flexible and safe.

关 键 词：单侧双通道关节镜技术 椎管减压 腰椎管狭窄症 老年人 

分 类 号：R681.57[医药卫生—骨科学] R687.3[医药卫生—外科学]