经椎间孔骨钻联合可视环锯内镜下治疗老年性腰椎侧隐窝狭窄临床疗效观察  

Clinical efficacy of endoscopic treatment of geriatric lumbar lateral recess stenosis by using bone drilling combined with visual trephine via transforaminal approach

作　　者：顾红林[1] 周敦[1] 施凤超[1] 祁玉贵 金顺利[1] 许步伟[1] 姚旺林 吕成堂 GU HonglinZHON Dun;SHI Fengchao;QI Yugui;JIN Shunli;XU Buwei;YAO Wanglin;LU Chengtang(Department of Spine Surgery,The Third People’s Hospital of Yancheng City,Jiangsu Province,Yancheng 224001;Yancheng Clinical Medical College of Nanjing Medical University,Yancheng 224001)

机构地区：[1]江苏省盐城市第三人民医院脊柱外科,盐城224001 [2]南京医科大学盐城临床医学院,盐城224001

出　　处：《颈腰痛杂志》2025年第1期171-175,共5页The Journal of Cervicodynia and Lumbodynia

基　　金：2018盐城市医学科技发展计划项目(2018YK2018120)。

摘　　要：目的观察经椎间孔骨钻联合可视环锯内镜下治疗老年性腰椎侧隐窝狭窄的临床疗效。方法本文回顾性分析2018年1月至2022年12月29例腰椎侧隐窝狭窄伴或不伴有椎间盘突出症患者接受经椎间孔入路骨钻联合可视环锯脊柱内窥镜治疗并随访其疗效。采用疼痛视觉模拟量表(VAS)评分及Oswestry功能障碍指数(ODI)评估疼痛缓解程度及腰椎功能改善情况,末次随访采用改良MacNab标准评价手术疗效。结果共有29例患者参加了这项研究,其中男15例,女14例,平均(73.00±2.99)岁,29例中无一例合并后凸畸形,其中8例合并冠状位退变畸形,Cobb角位于10°~30°,6例位于凹侧,2例位于凸侧;病程9~80个月,平均(47.14±20.70)个月。术前和术后1、3、6、12个月评估采用视觉模拟量表(VAS)和Oswestry残疾指数(ODI),并在最后一次随访时采用改良MacNab标准评估临床结果。术后1个月、3个月、6个月、12个月平均VAS评分ODI评分较术前差异有统计学意义(P<0.01)。在最后一次随访中,采用改良MacNab标准评价手术疗效,优15例,良12例,可1例,差1例,优良率为93.1%。1例患者获得了可的结果,术后局部皮肤麻木,通过口服消炎镇痛药控制症状。1例患者术后症状不能缓解获得差的结果,考虑侧隐窝减压不彻底而接受了开放手术,余无其他重大并发症。结论对于单侧骨性侧隐窝狭窄的患者,采用经椎间孔入路骨钻联合可视环锯内窥镜下治疗,骨钻技术提供了安全,有效、快速的工作通道的初步建立,镜下可视环锯成形,减少了盲视成形的射线的暴露量,直视下靶区操作,更安全,更精准成形上关节突骨质,减压侧隐窝背侧,扩大椎间孔,两者联合使用,给老年性侧隐窝狭窄的患者提供一个较为安全,有效的手术方案。Objective To describe the clinical efficacy of endoscopic treatment of lumbar bony lateral recess in the elderly by using bone drilling combined with visual trephine via transforaminal approach.Methods This paper retrospectively analyzed 29 patients with lumbar bony lateral Recess with or without disc herniation treated with bone drilling combined with visual trephine via transforaminal approach from January 2018 to December 2022 and followed up their efficacy.Pain relief and improvement in lumbar spine function were assessed using the visual analogue scale(VAS)score and Oswestry dysfunction index(ODI),and surgical efficacy was evaluated using modified MacNab criteria at the final follow-up.Results A total of 29 patients were enrolled in this study,15 men and 14 women,mean(73.00±2.99)years of age;Among the 29 cases,none of them were complicated with kyphosis.Among them,8 cases were complicated with coronal degeneration,with a cobb angle between 10°-30°,6 cases on the concave side,and 2 cases on the convex side.Duration of disease ranged from 9 to 80 months,mean(47.14±20.70)months.Preoperative and postoperative assessments at 1,3,6,and 12 months were performed using the VAS and ODI,and clinical outcomes were assessed using modified MacNab criteria at the last follow-up visit.At 1,3,6,and 12 months postoperatively.At the last follow-up,surgical efficacy was evaluated using modified MacNab criteria.The mean VAS score ODI score was statistically significant at 1 month,3 months,6 months,and 12 months postoperatively compared to preoperatively(P<0.01).The excellent rate was 93.1%in 15 cases,good in 12 cases,acceptable in 1 case,and poor in 1 case.One patient obtained an acceptable result with postoperative local skin numbness,which was controlled by oral anti-inflammatory and analgesic treatment.One patient had a poor outcome with no relief of postoperative symptoms,who was underwent open surgery considering incomplete decompression of the bony lateral recess stenosis.The rest had no other significant complications

关 键 词：腰椎侧隐窝狭窄 经皮全内镜下椎间孔成形术 经皮全内镜腰椎减压术 老年腰椎管狭窄症 侧隐窝 微创治疗 

分 类 号：R681.53[医药卫生—骨科学]