内镜下改良全椎板成形术治疗症状性腰椎管狭窄的效果分析

Effects of endoscopic modified total laminoplasty on symptomatic lumbar spinal stenosis

目的总结内镜下改良全椎板成形术(EMTL)的手术操作方法和经验,并探讨其治疗症状性腰椎管狭窄的早期疗效。方法回顾性分析郑州大学第一附属医院2016年8月至2017年8月接受EMTL治疗的22例腰椎管狭窄患者的临床资料。记录患者的年龄、住院时间、矢状面前后径、出血量、手术时间、切口长度及术中、术后并发症发生情况。手术疗效由术前及术后1年的腰痛和下肢痛视觉疼痛模拟评分(VAS)、Oswestry功能障碍指数(ODI)、日本矫形外科协会(JOA)评分进行评价。结果22例患者中男8例,女14例,年龄(59.3±9.6)岁;所有患者均患有神经源性间歇性跛行,跛行距离(339±130)m。术前DR、CT、MRI显示有8例患者伴有椎体滑脱/不稳。术后1年腰痛和下肢痛VAS、ODI、JOA评分与术前比较差异有统计学意义(P<0.05);腰痛VAS、下肢痛VAS、ODI评分、JOA评分的平均差异(95%置信区间)分别为5.0(4.3,5.6),4.1(3.3,4.8),38.6(35.7,1.5),-14.2(-16.2,-12.2),均较术前有明显恢复。术中出现1例硬膜损伤,术后复查见1例回植椎板未牢固融合,未见其他并发症发生。结论EMTL治疗症状性腰椎管狭窄的疗效确切,可减轻患者的症状,提高其生存质量和满意度,且操作安全。

Objective To summarize the operation procedure and experience of endoscopic modified total laminoplasty(EMTL),and to investigate its short-term therapeutic effects on symptomatic lumbar spinal stenosis.Methods The clinical data of 22 patients with lumbar spinal stenosis who underwent EMTL in the First Affiliated Hospital of Zhengzhou University from August 2016 to August 2017 were retrospectively analyzed.The age,hospital stay,prior and posterior diameters in sagittal plane,bleeding volume,operation time,incision length,intraoperative and postoperative complications of the two groups were recorded.The effects of operation were evaluated by the visual analogue scale(VAS)of lumbago and lower extremity pain,Oswestry disability index(ODI)and Japan Orthopedic Association(JOA)score before and 1 year after operation.Results Among the 22 patients,8 males and 14 females were included in the study,mean age(59.3±9.6)years.All patients had neurogenic intermittent claudication with a distance of(339±130)m.Eight patients showed spondylolisthesis or instability according to preoperative digital radiography(DR),computed tomography(CT)and magnetic resonance imaging(MRI).The VAS,ODI and JOA scores of lumbago and lower extremity pain 1 year after operation were significantly different from those before operation(P<0.05).The mean differences(95%confidence interval)of lumbago VAS,lower extremity VAS,ODI score and JOA score were 5.0(4.3,5.6),4.1(3.3,4.8),38.6(35.7,1.5),-14.2(-16.2,-12.2),respectively,which were significantly improved,compared with those before operation.There was 1 case of dural injury during the operation,and 1 case of replantation without fusion determined by postoperative reexamination.And there was no other complications.Conclusions EMTL is effective in the treatment of symptomatic lumbar spinal stenosis.It can alleviate the symptoms of patients,improve their quality of life and satisfaction,with good safety.