经椎间孔入路椎间孔镜下治疗腰椎管狭窄症的疗效分析

Efficacy analysis of transforaminal approach for amenoscope decompression in treatment of lumbar spinal stenosis

目的探讨经椎间孔入路椎间孔镜技术治疗各类腰椎管狭窄症的早期临床疗效及手术技巧。方法选取新疆医科大学第一附属医院2016年8月-2016年12月收治并行侧方椎间孔入路手术的各类腰椎管狭窄症患者50例,分别于术前及术后即刻、术后48h、术后1、3、6个月时使用视觉疼痛模拟评分(visual analogue scale,VAS)、日本骨科学会评分(japanese orthopaedic association,JOA)、Oswestry功能障碍指数(oswestry disability index,ODI)和改良Macnab疗效评定标准对手术疗效进行科学评价。共随访6个月。结果腰下肢疼痛VAS评分从术前的(4.50±1.15)分降至术后即刻的(2.44±0.97)分,术后6月时为(0.60±0.49)分,较术前有明显改善;术后6月时JOA评分从术前的(12.62±4.53)分提高至(23.36±2.95)分,ODI评分从术前(68.36±4.78)分降至(26.48±5.56)分,腰椎功能均有明显改善,改善率平均为(65.46±14.85)%。依据改良Macnab标准评估,优良率达96%。结论经椎间孔入路的椎间孔镜技术在治疗多种类型的腰椎管狭窄症中均显示了良好的临床疗效,以及较为广泛的适应证,值得推广。

Objective To evaluate the clinical efficacy of transforaminal approach foramenoscope decompression in treatment of various lumbar spinal stenosis to provide a scientific reference.Methods From August 2016 to December 2016,50 patients with various of lumber spinal stenosis were admitted to The First Affiliated Hospital of Xinjiang Medical University.All the patients were treated with transforaminal approach foramenoscope decompression,which was through L3/4,L4/5 two segments in 16 cases（32.0%）;L4/5,L5/S1 two segments in 1 cases（2.0%）;L4/5 bilateral stenosis in 6 cases（12%）and unilateral stenosis in 27 cases（54.0%）（L4/5 in 19 cases and L5/S1 in 8 cases）.The follow-up period was 6 months.The clinical efficacy was evaluated by Visual Analogue Scale（VAS）,Japanese Orthopaedic Association Scale（JOA）,Oswestry Disability Index（ODI）and the modified Macnab criteria at preoperative,postoperation,and in 48 hours,1 months,3 months,and 6 months after surgery.Statistic Parameters such as operation time,intraoperative blood loss,postoperative complications,hospital stays were analyzed.Results The VAS scores for low back and low limbs pain before operation were（4.50±1.15）,at postoperation and 6 months after surgery were（2.44±0.97）and（0.60±0.49）which was substantial improvement.The JOA scores were（12.62±4.53）before and improved into（23.36±2.95）at 6 months later.ODI scores were（68.36±4.78）and（26.48±5.56）respectively at preoperative and 6 months after the surgery.The lumber vertebral function were notable improved.The excellent and good results rate were achieved to 96% according to the Macnab criteria.Conclusion A good clinical efficacy and a wide range of indications were showed in the treatment of transforaminal approach foramenoscope decompression for various of lumbar spinal stenosis at early stage,which has a good clinical application value and is worthy of promoting.