机构地区:[1]上海市浦东新区人民医院骨科,上海201299
出 处:《中国修复重建外科杂志》2024年第3期337-341,共5页Chinese Journal of Reparative and Reconstructive Surgery
基 金:上海市浦东新区科技发展基金(PKJ2022-Y37);上海市自然科学基金项目(22ZR1455700);国家自然科学基金青年项目(82003132);上海市浦东新区学科建设重点学科(PWZxk2022-16)。
摘 要:目的 探讨单孔分体内镜(one-hole split endoscopy,OSE)技术治疗单节段腰椎管狭窄症(lumbar spinal stenosis,LSS)的临床疗效。方法 回顾分析2022年1月—12月收治且符合选择标准的32例采用OSE技术行单纯椎管减压治疗的单节段LSS患者临床资料。男18例,女14例;年龄45~82岁,平均65.1岁。病程9~72个月,平均34.9个月。手术节段:L3、43例,L4、519例,L5、S110例。记录切口长度、手术时间、术中出血量、术中放射暴露次数、术后下床活动时间及术前、术后1个月患者病变节段硬膜囊面积。通过术前,术后3 d、3个月、12个月疼痛视觉模拟评分(VAS)评估腰腿部疼痛情况;术前及术后3、12个月Oswestry功能障碍指数(ODI)评价功能恢复情况;末次随访时采用改良MacNab标准评估疗效。结果32例患者均顺利完成手术,切口长度平均2.05 cm,手术时间平均88.59 min,术中出血量平均46.72 mL,术中放射暴露次数平均3.84次,术后下床活动时间平均11.66 h。所有患者均获随访,随访时间12~16个月,平均13.5个月。1例患者术后出现下肢麻木、疼痛、肌力下降,其余患者未发生硬膜撕裂、重要神经损伤等并发症。术后各时间点患者腰、腿痛VAS评分及ODI均明显优于术前,且随时间延长各指标进一步改善,各时间点间差异均有统计学意义(P<0.05)。术后1个月患者病变节段硬膜囊面积为(123.13±19.66)mm2,较术前(51.25±9.50)mm2明显增大(t=-18.616,P<0.001)。末次随访时,采用改良MacNab标准评估疗效,获优18例、良11例、可3例,优良率90.6%。结论采用OSE技术行单纯椎管减压治疗单节段LSS临床疗效满意,具有手术创伤小、恢复快的优点。Objective To investigate the effectiveness of one-hole split endoscope(OSE)technique in the treatment of single segment lumbar spinal stenosis(LSS).Methods The clinical data of 32 single segment LSS patients treated with OSE technique for simple spinal canal decompression between January 2022 and December 2022,who met the selection criteria,were retrospectively analysed.There were 18 males and 14 females,the age ranged from 45 to 82 years,with an average of 65.1 years.The disease duration was 9-72 months,with an average of 34.9 months.The surgical segments included L3,4 in 3 cases,L4,5 in 19 cases,and L5,S1 in 10 cases.The incision length,operation time,intraoperative blood loss,intraoperative radiation exposure frequency,postoperative mobilization time,and the area of the patient’s lesion segment dural sac before operation and at 1 month after operation were recorded.Low back pain and leg pain were assessed by visual analogue scale(VAS)score before operation and at 3 days,3 months,and 12 months after operation;functional recovery was assessed by Oswestry disability index(ODI)before operation and at 3 months and 12 months after operation;the effectiveness was assessed by modified MacNab criteria at last follow-up.Results All 32 patients successfully completed the operation,with an average incision length of 2.05 cm,an average operation time of 88.59 minutes, an average intraoperative blood loss of 46.72 mL, an average intraoperative radiation exposure frequency of 3.84times, and an average postoperative mobilization time of 11.66 hours. All patients were followed up 12-16 months, with anaverage of 13.5 months. One patient experienced lower limb numbness, pain, and decreased muscle strength afteroperation, while the remaining patients did not experience complications such as dural tear or important nerve damage.The VAS scores of low back pain and leg pain and ODI in patients at various time points after operation were significantlybetter than preoperative ones, and each indicator further improved with time. The
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