内镜下经单侧入路行双侧椎管减压治疗退变性腰椎管狭窄症

Bilateral decompression in lumbar degenrative stenosis associated with unilateral approach under minimally invasive microendoscopy（METRx）

目的报道内镜（METRx）辅助下经单侧椎板间隙入路，行双侧中央椎管和侧隐窝减压，治疗退变性腰椎管狭窄症患者的手术技巧与临床效果。方法透视下经单侧置入18mm的METRx工作通道，术中通过调整METRx工作通道和内窥镜角度，经单侧椎板间隙入路行双侧中央椎管和侧隐窝减压，从而可保留棘上、棘间韧带和对侧的骨性椎板，以及不影响对侧软组织，临床治疗56例。结果单节段METRx操作时间平均94min，平均失血量为65ml，双节段操作时间平均135min，平均失血量为90ml，平均卧床时间6．5d。平均腰痛VAS指数从术前6．5降到术后平均3．1．平均腿痛VAS指数从术前7．2降到术后平均2．2，Oswestry功能指数（ODI）也从术前的平均46．8降到术后平均24．6，手术前后差异有统计学意义（P〈0．01）。Nakai分级评定手术的优良率为84％。结论内窥镜（METRx）辅助下经单侧椎板间隙入路，行双侧椎管治疗退变性腰椎管狭窄症，不但手术创伤小，而且安全有效。

Object To discuss the surgical techniques and the clinical outcomes of the bilateral microendoscopic decompression surgery for lumbar spinal canal and lateral recess stenosis through unilateral approach. Methods 18-mm-diameter mieroendoscopic tubular retractor was placed with fluoroscopic guidance, bilateral microendoscopic decompression surgery for lumbar spinal stenosis through unilateral approach were managed by adjusting the angle of tubular retractor. During the procedure, supra-interspinal ligament and contralateral bony lamina were well preserved. Results In the group of single-level microendoscopie decompression, the mean operation time was 94 min and the mean blood loss was 65 ml. In the group of twolevel microendoscopic decompression, the mean operation time was 135 min and the mean blood loss was 90 ml. The mean bed rest time was 6.5 days. After operation, the average back pain VAS score decreased from 6.5 to 3.1, the average leg pain VAS score decreased from 7.2 to 2.2, the average Oswestry Disability Index （ODI） decreased from 46.8 to 24.6, which had shown significant statistical difference before and after surgery （P 〈 0.05）. According to Nakai criteria, the excellent and good rate was 84%. Conclusion Bilateral microendoscopic decompression of lumbar canal through unilateral approach under METRx system offers a save, effective and minimal invasive option for lumbar spinal stenosis.