关节突定位滑移技术椎间孔成形在经皮脊柱内镜治疗腰椎管狭窄症的运用效果

Application effect of articular process positioning and sliding technique for intervertebral foraminoplasty in the treatment of lumbar spinal stenosis with percutaneous spinal endoscopy

目的探讨关节突定位滑移技术椎间孔成形在经皮脊柱内镜治疗腰椎管狭窄症(lumbar spinal stenosis,LSS)的运用效果。方法本研究对象为2017年12月~2019年12月于本院收治的34例LSS患者,均采用经皮脊柱内镜手术治疗,采用关节突定位滑移技术进行术中椎间孔成形,根据后纵韧带后缘线分为上下部分,进行上-下-上分区减压。记录患者术中指标以及术后并发症发生情况;术前、术后3个月、术后12个月分别采用VAS评分评估腰、腿疼痛症状,采用Oswestry功能障碍指数(Oswestry disability index,ODI)评估腰椎功能障碍,术后12个月时采用改良MacNab疗效评价标准评估手术综合疗效。结果所有患者均完成手术,手术用时(62.98±6.82)min,透视次数(8.87±2.08)次,住院天数(4.84±0.70)d;术后1例患者出现反复根性症状,1例发生脑脊液漏,1例患者复发。术后3个月、12个月的腰、腿VAS评分以及ODI指数均显著降低(P<0.05);术后12个月,手术优良率为91.18%。结论经皮脊柱内镜治疗LSS时采用关节突定位滑移技术进行术中椎间孔成形,手术时间短、透视次数少,在改善腰、腿疼痛及功能障碍方面效果满意。

Objective To explore the effect of articular process positioning and sliding technique for intervertebral foramina in the treatment of lumbar spinal stenosis(LSS).Methods To explore the effect of articular process positioning and sliding technique for intervertebral foramina in the treatment of lumbar spinal stenosis(LSS).Methods Thirty-four patients with LSS in our hospital from December 2017 to December 2019 were selected in this study,and all of them were treated with percutaneous spinal endoscopy.The articular process positioning slip technique was used for intraoperative foramen formation,which was divided into upper and lower parts according to the posterior edge line of the posterior longitudinal ligament,and upper-inferior-upper zone decompression was performed.The intraoperative indicators and postoperative complications were recorded.The visual analog scale(VAS)was used to evaluate the symptoms of waist and leg pain before operation,3 months after operation,and 12 months after operation.The Oswestry dysfunction index(ODI)was used to evaluate lumbar spine dysfunction,and the modified MacNab efficacy evaluation standard was used to evaluate the comprehensive efficacy of the operation at 12 months after surgery.Results All patients completed the operation.The operation time was(62.98±6.82)min,the number of fluoroscopy was(8.87±2.08)times,and the hospital stay was(4.84±0.70)d.After operation,1 patient developed recurrent radiculopathy,1 patient developed cerebrospinal fluid leakage,and 1 patient relapsed.The waist and leg VAS scores and ODI index decreased significantly at 3 months and 12 months after operation(P<0.05).Twelve months after operation,the MacNab efficacy evaluation criteria showed that the excellent and good rate of the operation was 91.18%.Conclusion In the percutaneous spinal endoscopic treatment of LSS,the articular process positioning slip technique is used to perform intraoperative foraminoplasty with short operation time and fewer fluoroscopy times.The effect is satisfactory in improving waist and leg pain and dysfunction.