经皮椎间孔镜ULESS技术治疗腰椎单侧侧隐窝狭窄症的临床疗效观察

Observation of the Clinical Effect of ULESS Technique in the Treatment of Lumbar Spine Unilateral Recess Stenosis

目的:探讨经皮腰椎间孔镜ULESS技术治疗腰椎单侧侧隐窝狭窄症的临床疗效。方法:对腰椎单侧侧隐窝狭窄症的患者采用经皮椎间孔镜下ULESS技术行髓核摘除、椎管减压及微创射频消融术,其中取得完整随访30例患者,收集手术前及手术后1 d、术后1周、术后3个月、术后6个月腿痛VAS评分评价疼痛改善情况,手术前及手术后3个月、手术后6个月采用ODI评分评价功能障碍改善情况,手术后6个月运用MacNab标准评价临床疗效。结果:获得6个月随访的患者30例,均未出现神经血管损伤、感染等并发症。术后1 d、1周、3个月、6个月下肢疼痛VAS评分分别为(2.21±0.80)分、(1.75±0.75)分、(1.65±0.58)分及(1.50±0.78)分,与术前(6.21±1.27)分比较差异均有统计学意义(P<0.05),手术后3个月、手术后6个月ODI评分分别为(12.36±4.11)%、(12.56±3.25)%与术前(61.65±4.80)%比较,差异皆有统计学意义(P<0.05)。术后6个月运用MacNab标准对疗效评估:优15例、良13例、可2例,优良率93.33%。结论:经皮椎间孔镜下ULESS技术治疗腰椎单侧侧隐窝狭窄症是一种安全、有效、微创的方法,值得临床推广。

Objective:To investigate the clinical effect of ULESS technology in the treatment of unilateral crypt stenosis of the lumbar spine.Methods:Patients with degenerative lumbar spinal stenosis were treated with ULESS technique under percutaneous transforaminal endoscopy for pathological segmental nucleus pulposus excision,spinal canal decompression and minimally invasive radiofrequency ablation.A complete follow-up of 30 patients was obtained.VAS score and ODI score were used to evaluate pain and dysfunction before and 1 day,1 week,3 months,and 6 months after operation.The MacNab score was used to evaluate the clinical efficacy at 6 months after operation.Results:Thirty patients who were followed up for 6 months had no complications such as neurovascular injury and infection.The VAS scores of lower limb pain at 1 day,1 week,3 months,and 6 months after operation were(2.21±0.80),(1.75±0.75),(1.65±0.58)and(1.50±0.78)points respectively,and before operation(6.21±1.27),the difference was statistically significant(P<0.05).The ODI scores at 3 months after surgery and 6 months after surgery were(12.36±4.11)%,(12.56±3.25)% and(61.65±4.80)% before surgery,the difference was statistically significant(P<0.05).six months after the operation,the efficacy was evaluated according to the MacNab scoring standard of the spine:15 cases were excellent,13 cases were good,2 cases were fair,and the excellent and good rate was 93.33%.Conclusion:ULESS technique under percutaneous transforaminal endoscopy is a safe,effective and minimally invasive method for the treatment of unilateral crypt stenosis of the lumbar spine,and it is worthy of clinical promotion.