经皮脊柱内镜治疗腰椎管内骨性占位的短期临床疗效

Short-term clinical effectiveness of percutaneous endoscopy spine surgery for lumbar intraspinal bonyoccupying lesion

目的探讨经皮脊柱内镜椎板间入路(percutaneous endoscopic interlaminar discectomy,PEID)治疗腰椎管内骨性占位的短期临床疗效。方法回顾性分析2016年2月至2017年8月,我科采用PEID治疗腰椎管内骨性占位患者共58例,其中钙化型腰椎间盘突出症患者40例,椎体后缘离断症患者18例;男32例,女26例,年龄17～75岁,平均(37.75±2.51)岁,病程3个月至7年,中位病程14个月,随访12～15个月。采用疼痛数字评价量表(numerical rating scale,NRS)、Oswestry功能障碍指数(oswestry disability index,ODI)及改良日本骨科协会脊柱评分(modified Japanese orthopedic association,mJOA)在术前、术后3个月及末次随访时进行评估,并于末次随访时采用改良MacNab分级标准评价临床效果。结果所有患者均顺利完成手术,平均手术时间(82.3±17.32) min。所有患者术后腰腿疼痛、感觉肌力减退较术前均有不同程度的缓解。钙化型椎间盘突出症患者术前、术后3个月及末次随访NRS评分分别为(7.63±0.628)分,(1.93±0.829)分,(1.70±0.687)分;ODI评分分别为(51.60±2.329)分,(23.23±1.291)分,(22.80±1.244)分;mJOA评分分别为(8.03±0.698)分,(18.63±0.740)分,(18.83±0.813)分;改善率为51.50%。椎体后缘离断症患者术前、术后3个月及末次随访NRS评分分别为(8.17±0.786)分,(2.22±0.878)分,(2.11±0.900)分;ODI评分分别为(48.39±2.477)分,(23.33±1.138)分,(23.06±0.802)分;mJOA评分分别为(7.78±0.808)分,(19.06±0.639)分,(19.11±0.832)分,改善率为53.39%。所有患者术后3个月、末次随访NRS、ODI评分分别与术前相比,显著减少,差异有统计学意义(P<0.05),术后两次随访结果相比差异无统计学意义(P>0.05);而术后3个月、末次随访mJOA评分分别与术前相比,显著增加,差异有统计学意义(P<0.05);术后两次随访结果相比较差异无统计学意义(P>0.05)。末次随访时使用改良MacNab标准,总体优良率为89.66%。结论经皮脊柱内镜下治疗腰椎管内骨性占位具有创伤小,出血少,术后恢复快等优点及较高的安全性,可根据临床实际情况选择恰当的手术策略,其短期疗效确切,长期疗效需要进一步随访。

Objective To investigate the short-term clinical effectiveness of percutaneous endoscopy spine surgery via Interlaminar approach for lumbar intraspinal bonyoccupying lesion. Methods We retrospectively analyzed 58 patients diagnosed with lumbar intraspinal bonyoccupying and treated by percutaneous endoscopy spine surgery via interlaminar approach from February 2016 to August 2017, including calcified lumbar disc herniation in 40 cases and posterior ring apophysis separation in 18. Of them, 32 males and 26 females ranged in age from 17 to 75 with an average of (37.75 ± 2.513) years, and suffered from the diseases from 3 months to 7 years. The median course was 14 months and the follow-up ranged from 12 to 15 months. Numerical rating scale (NRS), Oswestry disability index (ODI) and modified Japanese orthopedic association (mJOA) were used to evaluate outcomes at preoperation, 3 months postoperatively and final follow-up. At the final follow-up, the clinical effects were evaluated by modified MacNab criteria. Results All surgeries were successful with less blood loss. The average operation time was (82.3 ± 17.32) minutes. Sensory disturbance, muscle weakness, low back and leg pain were alleviated in different degrees after the operation. The NRS scores of patients with calcified lumbar disc herniation were (7.63 ± 0.628) at pre-operation, (1.93 ± 0.829) 3 months postoperatively, and (1.70 ± 0.687) at the final follow-up. The ODI scores of patients with calcified lumbar disc herniation were (51.60 ± 2.329) at pre-operation, (23.23 ± 1.291) 3 months postoperatively, and (22.80 ± 1.244) at the final follow-up. The mJOA scores of patients with calcified lumbar disc herniation were (8.03 ± 0.698) at pre-operation, (18.63 ± 0.740) 3 months postoperatively, and (18.83 ± 0.813) at the final follow-up. The recovery rate was 51.50%. The NRS scores of patients with posterior ring apophysis separation were (8.17 ± 0.786) at pre-operation, (2.22 ± 0.878) 3 months postoperatively, and (2.11 ± 0.900) at the final follow-up. The ODI scores of patients with posterior ring apophysis separation were (51.60 ± 2.329) at pre-operation, (23.23 ± 1.291) 3 months postoperatively, and (22.80 ± 1.244) at the final follow-up. The mJOA scores of patients with posterior ring apophysis separation were (7.78 ± 0.808) at pre-operation, (19.06 ± 0.639) 3 months postoperatively, and (19.11 ± 0.832) at the final follow-up. The recovery rate was 53.39%. The NRS, ODI scores of all patients decreased significantly 3 months postoperatively and at the final follow-up compared with those at preoperation (P < 0.05). No differences were observed between NRS, ODI scores 3 months postoperatively and at the final follow-up (P > 0.05). The mJOA score significantly increased 3 months postoperatively and at the final followup compared with that at pre-operation (P < 0.05). No differences were observed between mJOA scores 3 months postoperatively and at the final follow-up (P > 0.05). Modified MacNab criteria was used in final follow-up, and the overall excellent and good rate was 89.66%. Conclusions Percutaneous spinal endoscopy is less invasive with less bleeding, quicker postoperative recovery and higher safety in the treatment of lumbar intraspinal bonyoccupying lesion. Appropriate surgical strategy could be selected according to the actual clinical conditions. The short-term clinical efficacy is good, and long-term clinical efficacy requires further follow-up.