经皮椎间孔入路内镜下减压治疗单节段老年腰椎侧隐窝狭窄症36例

Treatment of 36 cases of unilateral lumbar lateral recess stenosis by percutaneous endoscopic decompression

目的探究经皮椎间孔入路内镜下减压治疗单节段老年腰椎侧隐窝狭窄症的临床疗效与安全性。方法选择2015-08-2016-08于我院接受经皮椎间孔入路内镜下减压治疗的36例单节段老年腰椎侧隐窝狭窄症患者,术后第2d评估椎间孔成形、侧隐窝减压情况;手术前后统计对比腿痛视觉模拟评分(VAS)以及Oswsetry功能障碍指数(ODI);经Mac Nab评估临床疗效。结果 36例患者均顺利完成手术,平均手术时间为(78.4±31.3)min;患者均接受随访,平均随访时间为(28.6±15.6)个月;患者伴有内科疾病均未加重,平均住院天数为(2.1±0.7)d;患者术后1个月、3个月、6个月、12个月VAS评分、ODI评分较于术前明显改善(P<0.05);经Mac Nab疗效评价,治疗优良率为86.1%;2例术后下肢麻木,经营养神经治疗2周后逐渐恢复。全部患者未出现伤口裂开、伤口感染、硬脊膜撕裂引发脑脊液漏、下肢深静脉血栓等相关并发症。结论经皮椎间孔入路内镜下减压治疗老年单节段腰椎侧隐窝狭窄症患者,可有效减轻疼痛,改善功能障碍;同时该术式能够在局麻下进行,对患者全身影响较小,以控制并发症发生,具有微创、安全、有效等优势。

Objective To explore the clinical curative effect and security of percutaneous intervertebral foramen in the endoscopic decompression treatment of single segment of senile lumbar lateral recess stenosis disease. Methods From August 2015 to August 2016, 36 elderly patients with single segment of lumbar lateral recess stenosis in our hospital who accepted percutaneous intervertebral foramen in the endoscopic decompression for the treatment were selected. At postoperative 2 d, the intervertebral foramen, compassion fossa decompression situation were assessed.Before and after surgery, the leg pain VAS and ODI were compared. The clinical curative effect was assessed by the Mac Nab. Results 36 patients were successfully completed surgery, average operation time was（78.4 ±31.3） min. Patients were followed up, with an average time of follow-up was（28.6±15.6） months. Patients had not been accompanied by medical disease aggravating, average hospitalization time was（2.1 ±0.7）d. At postoperative 1 month, 3 months, 6 months, 12 months, the VAS score, ODI score were obviously improved than preoperation（P〈0.05）. The Mac Nab evaluation results showed that the excellent and good rate of treatment was 86.1%; 2 cases of postoperative lower limb numbness, gradually recovered after 2 weeks of nourishing nerve treatment. All patients did not appear the wound dehiscence, wound infection, catheter tear causes cerebrospinal fluid leakage, lower extremity deep vein thrombosis and related complications.Conclusion Percutaneous intervertebral foramen in the endoscopic decompression in treatment of elderly single segmental lumbar lateral recess stenosis, can effectively alleviate pain, improve dysfunction. At the same time, the surgery under local anesthesia, the patients＇ body was less affected, thus can control the complications, has the advantages of minimally invasive,safe and effective.