经皮大直径全内镜下经椎板间入路治疗腰椎管狭窄症的疗效评价

Efficacy assessment of percutaneous large diameter full-endoscopic in treatment of lumbar spinal stenosis

目的评价经皮椎板间入路大直径全内镜下治疗腰椎管狭窄症的临床效果。方法回顾性分析2016年1月～2018年5月西南医科大学附属成都363医院骨科收治的腰椎管狭窄症患者46例,均为单一节段狭窄,类型包括侧椎管狭窄、中央管狭窄及混合狭窄。根据狭窄类型,中央管狭窄采用经皮大直径全内镜下椎板开窗减压,侧方椎管狭窄及混合型狭窄采用内镜下椎板开窗+神经根管减压,伴有椎间盘突出同时行髓核部分摘除术,双侧狭窄时采用一侧入路双侧减压。采用腰痛及腿痛VAS评分,ODI指数和改良MacNab疗效评分评估术后短期疗效。结果 46例患者均顺利完成手术,手术时间(92.25±19.63)min,术中出血量(15.52±6.78)ml,住院时间5～10d,平均6.6d。患者均获随访,随访时间3～24个月,平均14个月。术前腰痛VAS评分为(5.55±0.83),术后即刻为(2.65±0.75)分,术后3个月为(2.35±0.67)分,术后6个月为(2.20±0.52)分及末次随访为(2.05±0.39)分。术前腿痛VAS评分为(5.65±1.13)分,术后即刻为(2.45±0.98)分,术后3个月为(2.35±0.87)分,术后6个月为(2.15±0.67)分及末次随访为(2.05±0.51)分。术前与术后VAS评分比较,差异有统计学意义(P<0.05)。术前ODI评分(73.15±9.92)%,术后即刻(29.20±7.81)%,术后3个月(25.55±5.01)%,术后6个月为(20.90±4.76)%,末次随访为(18.85±4.26)%,术后与术前相比,差异均有统计学意义(P<0.05)。末次随访采用改良MacNab评价疗效,其中优为35例,良为7例,可为3例,差为1例,优良率占91.3%。结论经皮大直径内镜系统治疗腰椎管狭窄症具有创伤小,恢复快等优点,是一种安全、高效的微创手术。

Objective To evaluate the clinical effect of percutaneous large diameter Fullendoscopic interlaminar approach in the treatment of lumbar spinal stenosis.Methods 46 patients of lumbar spinal stenosis admitted to AVIV 363 hospital from January 2016 to May 2018 with single level stenosis were involved in the present study. Types of stenosis included lateral spinal canal stenosis, central canal stenosis, and mixed stenosis. According to the type of stenosis, the central canal stenosis was decompressed by percutaneous full-endoscopic laminar fenestration, the lateral spinal canal stenosis and mixed stenosis were decompressed by percutaneous fullendoscopic Laminar fenestration and nerve root canal decompression. Partial excision of nucleus pulposus was performed with herniation of intervertebral disc and bilateral decompression via unilateral approach for bilateral stenosis.using the VAS of low back pain and leg pain, Oswestry disability index and a modified Macnab’s criterion evaluate the shortterm outcome. Results 46 cases successfully completed surgery. The operative time was (92.25±19.63) min, intraoperative bleeding volume (15.52±6.78) ml, hospitalization time 5.10 days (mean 6.6 days). All patients were followed up for 12-18 months (mean 14 months). The VAS score of low back pain was (5.55±0.83) score before operation,(2.65±0.75) score immediately after operation,(2.35±0.67) score at 3 months after operation,(2.20±0.52) score at 6 months after operation and (2.05±0.39)score at last follow-up. The VAS score of leg pain was (5.65±1.13) score before operation,(2.45±0.98) score immediately after operation,(2.35±0.87) score at 3 months after operation,(2.15±0.67) score at 6 months after operation and (2.05±0.51) score at last follow-up after operation. There was a significant difference between preoperative and postoperative VAS scores (P<0.05).The ODI scores were (73.15±9.92)% in preoperative,(29.20±7.81)% in immediate postoperation,(25.55±5.01)% in 3 months after operation ,(20.90±4.76)% in 6 months after operation and (18.85±5.33)% in the last follow-up. Improved macnab was used to evaluate the curative effect. There were excellent in 35 cases, good in 7 cases, fair in 3 cases, poor in 1 case. The excellent and good rate was 91.3%.Conclusion Percutaneous large diameter endoscopy is a safe and effective minimally invasive operation for lumbar spinal stenosis.