经皮全脊柱内镜技术治疗青少年腰椎椎体后缘离断症

Percutaneous full-endoscopic technique for treatment of posterior lumbar apophyseal ring fractures in adolescents

[目的]探讨经皮全脊柱内镜技术治疗青少年腰椎椎体后缘离断症的疗效。[方法]2012年9月~2015年9月采用经皮全脊柱内镜技术治疗腰椎椎体后缘离断症患者28例,男17例,女11例;年龄16~25岁,平均18.80岁。责任节段L_(2/3)1例、L_(3/4)6例、L_(4/5)15例、L_5/S_1 6例。25例采用经椎间孔入路,3例采用经椎板间入路。[结果]手术时间60~170 min,平均90 min。1例经椎板间隙入路手术术中发生硬脊膜撕裂而中转开放手术,所有病例均未出现神经根及马尾损伤并发症。1例术后第5 d出现手术节段椎间盘突出,采用显微内窥镜下椎间盘摘除术翻修;其余26例患者随访12~36个月,平均18.80个月。末次随访时VAS评分由术前的(5.81±2.73)分下降至(1.63±1.12)分(P<0.05),腿痛VAS评分由术前的(5.74±2.30)分下降至(0.81±0.55)分(P<0.05),ODI由术前的(52.55±19.22)%降至(11.88±7.60)%(P<0.05)。Mac Nab法疗效评定结果优18例、良7例、可1例。[结论]经皮全脊柱内镜技术治疗青少年腰椎椎体后缘离断症能保留腰椎活动度、明显缓解症状,术后近期疗效良好。术后12个月腰椎MRI显示手术节段椎体后缘获得良好塑型。

[ ObjeCtive] To evaluate the feasibility and clinical outcome of percutaneous full-endoscopic surgery for treat - ment of posterior lumbar apophyseal ring fractures in adolescents. [Methods] Twenty-eight patients with posterior lumbar apophyseal ring fractures, including 17 male and II female aged 18.8 years on average （range, 16-25） , were treated by percutaneous full-endoscopic technique. The responsible discs located at L2n in 1 patient, L3/4 in 6, L4/5 in 15 and L5/S1 in 6. The transforaminal approach was used in 25 patients, while interlaminar approach applied in the remaining 3 patients. VAS, ODI and MacNab criteria were used to evaluate the clinical outcomes. [Result] The operation lasted for 90 min on average （range, 60-170 min） . A patient was changed to open surgery due to dural tear during endoscopy, nevertheless no injury of nerve root or cauda equina occurred in anyone of the other patients. Recurrence was noted in only 1 patient at 5 days after primary opera- tion and revisional microendoscopic discectomy was performed. The remaining 26 patients were followed up for 12 to 36 months, with an average of 18.8months. VAS of low back pain significantly decreased from （5.81±2.73） preoperatively to （1.63±1.12） at the latest follow up （P〈0.05） , equally VAS of leg pain substantially reduced from （5.74±2.30） to （0.81± 0.55） （P〈0.05） . In addition, ODI significantly diminished from （52.55±19.22） before operation to （11.88±7.60） at the final follow up （P〈0.05） . In term of MacNab scale, clinical outcome was graded as excellent in 18 patients, good in 7, and fair in 1. All of the 26 patients achieved satisfactory remolding of the vertebral posterior rims on the MRI at 12 months after opera- tion. [Conclusion] Posterior lumbar apophyseal ring fractures in adolescents can be treated successfully with percutaneous full-endoscopic surgery with satisfactory short-term results.