经皮椎间孔入路内镜下选择性责任节段减压治疗老年腰椎侧隐窝狭窄症

Percutaneous Endoscopic Transforaminal Approach Selective Responsible Segment Decompression for Lumbar Lateral Recess Stenosis in Elderly Patients

目的探讨经皮椎间孔入路内镜下选择性责任节段减压治疗老年腰椎侧隐窝狭窄症的效果。方法2014年5月~2016年7月我科对81例神经根阻滞明确责任节段的老年腰椎侧隐窝狭窄症在局部麻醉下行椎间孔镜下椎间孔入路椎管扩大减压术。椎间孔成形后,切除突出的髓核组织及增厚的黄韧带,将侧方的椎管打开,神经根完全松弛。术后1、6、12个月及末次随访进行Oswestry功能障碍指数(Oswestry Disability Index,ODI),腰、腿疼痛视觉模拟评分(Visual Analogue Scale,VAS),改良MacNab标准评价疗效。结果81例均完成手术,手术时间57~138 min,(68.4±31.9)min。81例随访24~48个月,(29.5±3.8)月。术后1、6、12个月及末次随访时ODI、腰痛VAS评分及腿痛VAS评分较术前显著好转(P<0.05)。末次随访改良MacNab标准评估,优57例,良18例,可6例,优良率92.6%(75/81)。结论经皮椎间孔入路内镜下选择性责任节段减压治疗老年腰椎侧隐窝狭窄症,能很好地缓解症状,严重并发症少。

Objective To discuss the effect of percutaneous endoscopic transforaminal approach selective responsible segment decompression for lumbar lateral recess stenosis in the elderly.Methods From May 2014 to July 2016,81 cases of senile lumbar lateral recess stenosis with definite responsible segment for nerve root block were included.All the patients underwent decompression through foramen under local anesthesia.After the intervertebral foraminoplasty,the protruding nucleus pulposus tissue and the thickened ligamentum flavum were removed.The lateral spinal canal was opened and the nerve root was completely relaxed.The Oswestry Disability Index(ODI),the Visual Analogue Scale(VAS)of the pain of the waist and lower limbs and the clinical efficacy of improved MacNab were evaluated at the time of 1,6,12 months and final follow-up.Results The operations were completed in all the 81 patients.The operation time was 57-138 min,with an average of(68.4±31.9)min.The follow-up time was 24-48 months,with an average of(29.5±3.8)months.After 1,6,12 months and the last follow-up,the ODI,the VAS scores of low back pain and the leg pain were significantly improved,and the differences were statistically significant as compared with those before operation(P<0.05).At the last follow-up,the modified MacNab criteria assessed excellent outcomes in 57 cases,good in 18 cases,and fair in 6 cases,with an excellent and good rate of 92.6%(75/81).Conclusion Selective responsible segment decompression under percutaneous endoscopy for the treatment of lumbar lateral recess stenosis in the elderly can relieve symptoms well and decrease serious complications.