经皮椎间孔镜治疗腰椎管狭窄症临床疗效评价

Clinical effects of percutaneous endoscopic transforaminal decompression for the treatment of lumbar spinal stenosis

目的:评价经皮椎间孔镜入路治疗腰椎管狭窄症的临床疗效,从而对临床手术适应证的选择提供一定的理论依据。方法:对2014年6月到2016年1月收治的87例腰椎管狭窄症患者的临床资料进行回顾性分析,其中男45例,女42例;年龄25～81岁,平均55.14岁;L_(3,4)8例,L_(4,5)61例,L_5S_118例,均采用经皮椎间孔镜经椎间孔入路进行减压手术。术前,术后3、6个月对患者的临床症状及神经功能采用VAS、ODI进行评估,并采用MacNab评分标准对疗效进行评定。结果:87例患者术后伤口均愈合良好,无并发症,均获得6个月以上的随访。术前及术后3、6个月,VAS评分(评分表按mm计算,总分为100分)分别为63.88±8.56、13.22±8.24、6.83±9.43;ODI评分为59.96±12.60、9.08±10.55、5.64±6.84,术后3、6个月与术前比较,差异有统计学意义(P<0.01)。按照MacNab标准评定疗效,结果优41例,良30例,可7例,差9例。结论:经皮椎间孔镜入路治疗腰椎管狭窄症如果适应证选择恰当可以达到比较好的临床效果,对于黄韧带肥厚或者合并一些骨化狭窄的患者,则不能充分减压可能导致治疗效果不理想。

Objective：To evaluate clinical effects of lumbar spinal stenosis by endoscopic transforaminal decompression,and to provide a theory basis for selection of surgical candidates. Methods：From June 2014 to January 2016,clinical data of87 patients with lumbar spinal stenosis were retrospectively analyzed,including 45 males and 42 females,aged from 25 to 81 years old with an average of 55.14 years old; 8 cases on L3,4,61 cases on L4,5,18 cases on L5S1. All patients underwent percutaneous edoscopic transforaminal decompression. Clinical symptoms and nerve functions were evaluated by VAS,ODI before operation,3 and 6 months after operation,MacNab scoring was used to evaluate clinical effects. Results：Postoperative incision of87 patients healed well without complications,and obtained more than 6 months follow up. VAS score before operation,3 and 6 months after operation respectively were 63.88±8.56,13.22±8.24,6.83±9.43 respectively;ODI score before operation,3 and 6 months after operation were 59.96 ±12.60,9.08 ±10.55,5.64 ±6.84 respectively. There was statistical significance in VAS and ODI score compared before operation and 3 and 6 months after operation. According to MacNab scoring,41 cases obtained excellent results,30 good,7 moderate and 9 poor. Conclusion：Percutenous endoscopic transforaminal decompression for lumbar spinal stenosis could reach good clinical effects if choosing appropriate indications. For patients with yellow ligament hypertrophy or combined with some ossified stenosis,insufficient decompression may result in poor therapeutic effects.