经皮通道单侧半椎板入路显微切除腰椎管内囊肿

Microsurgical resection of lumbar intraspinal cysts through unilateral hemilaminectomy approach using percutaneous tubular retractor system

目的探讨经皮通道单侧半椎板入路显微手术切除腰椎管内囊肿的临床疗效。方法回顾性分析自2014年6月-2018年1月在我科采用经皮通道单侧半椎板入路显微手术切除的13例腰椎管内囊肿患者的资料及临床恢复情况,其中滑膜囊肿5例,腱鞘囊肿3例,脊膜囊肿3例,表皮样囊肿2例,于术前和末次随访均采用视觉模拟评分法（Visual Analogue Scale, VAS）和日本骨科学会评分（Japanese Orthopedic Association, JOA）来评估临床疗效。术后1周行腰椎CT三维重建,术后随访行腰椎MRI平扫和增强。结果手术时间74-200 min,平均119.2 min;术中出血量40-105 ml,平均61.5 ml;住院时间5-10 d,平均6.7 d;随访4-47月,平均23.8月。所有患者完全切除囊肿,无神经损伤、脑脊液漏等并发症。JOA评分和VAS评分较术前均得到显著改善,术后CT三维重建示单侧半椎板开窗范围,随访期间未见囊肿复发,无腰椎畸形或脊柱失稳的并发症。结论经皮通道单侧半椎板入路显微切除腰椎管内囊肿,具有创伤小、术后恢复快、临床疗效确切等优点,且很好保护了脊柱稳定性,值得临床推广。

Objective To investigate the clinical effect of using percutaneous tubular retractor system on microsurgical resection of lumbar intraspinal cysts via unilateral hemilaminectomy. Methods We performed a retrospective analysis of the clinical data of 13 patients with lumbar intraspinal cysts treated via a unilateral hemilaminectomy approach using percutaneous tubular retractor system from June 2014 to January 2018, including synovial cyst（n=5）, ganglion cyst（n=3）, meningeal cyst（n=3） and epithelioid cyst（n=2）. Clinical outcomes were assessed using the visual analog scale（VAS） and the Japanese Orthopedic Association（JOA） scale. Computed tomography（CT） three-dimensional reconstruction of lumbar vertebrae was performed l week postoperatively, MRI plain scan and enhanced scan of lumbar vertebrae were conducted during the follow-up period. Results Mean operative time was 119.2 min（ranging from 74 to 200 min）.Mean blood loss during surgery was approximately 61.5 m L（ranging from 40 to 105 mL）. The mean duration of hospital stay was 6.7 days（ranging from 5 to 10 days）. Patients were followed-up for a period of between 4 months and 47 months, with a mean follow-up time of 23.8 months. Complete resection was achieved in all patients without nerve root injury or cerebrospinal fluid leakage. Postoperative scores of VAS and JOA improved significantly versus preoperative ones（P0.05）. No postoperative spinal instability was identified by CT three-dimensional reconstruction of lumbar vertebrae, and no evidence of recurrence or secondary spinal deformity was observed in any patients during the postoperative follow-up period. Conclusion Unilateral hemilaminectomy approach using percutaneous tubular retractor system can be used to treat lumbar intraspinal cysts, such surgical procedures have characteristics of less trauma, faster recovery, reliable clinical effect and good postoperative spinal stability, which is worth of clinical promotion.