经皮腰椎全内镜下单侧入路双侧减压治疗单节段腰椎椎管狭窄症的临床疗效分析

Percutaneous endoscopic unilateral laminotomy and bilateral decompression in the treatment of single-segment lumbar spinal stenosis

目的探讨经皮腰椎全内镜下单侧入路双侧减压(percutaneous endoscopic unilateral laminotomy and bilateral decompression,Endo-ULBD)治疗腰椎椎管狭窄症(lumbar spinal stenosis,LSS)的临床疗效.方法回顾性分析2019年5月至2020年8月,于我院就诊住院的单节段LSS患者50例,其中男23例,女27例,年龄47~90岁,平均(65.6±10.9)岁.病变节段包括L_(3~4)3例、L_(4~5)33例、L_(5)-S_(1)14例.术前腰腿疼痛视觉模拟评分(visual analog scale,VAS)5~9分,平均(6.24±0.98)分;腰椎Oswestry功能障碍指数(oswestry disability index,ODI)26~39,平均(31.8±3.4)(此组病例均只包括除"性生活"以外的9个问题,总分45).所有患者均采用Endo-ULBD治疗,术后随访1年以上.术后第2~3天复查腰椎MRI或CT以评估椎管扩大成形、硬膜囊及双侧神经根减压的情况.术后2天、3个月、6个月、12个月进行随访,采用改良MacNab评估患者腰椎功能的恢复情况.结果术后复查腰椎MRI及CT显示椎管及双侧神经根减压充分.术后无感染、无严重神经根损伤和腰椎不稳定等并发症.50例均获得完整随访数据,随访时间12~16个月,平均(13.0±0.8)个月.随访各时间点腰腿痛VAS评分及腰椎功能ODI均较前次随访降低,差异有统计学意义(P<0.01).术后12个月或末次随访MacNab评估:优10例,良36例,可4例,优良率90.0%.结论Endo-ULBD是一种治疗单节段LSS的微创、高效、安全的手术方法.

Objective To Observe the efficacy of percutaneous endoscopic unilateral laminotomy and bilateral decompression(Endo-ULBD)in the treatment of single-segment lumbar spinal stenosis(LSS).Methods In our retrospective investigation,a total of 50 patients were enrolled between May 2019 and August 2020;23 patients were males,and 27 were females.The average age was(65.6±10.9)years(range:47-90 years).Lesions included L_(3-4)(3 cases),L_(4-5)(33 cases)and L_(5)-S_(1)(14 cases).Visual analogue scale(VAS)was used to evaluate the preoperative and postoperative pain,and the Oswestry Disability Index(ODI)and modified MacNab scores were used to evaluate lumbar function and quality of life,respectively.VAS of preoperative lumbar and leg pain was 5-9,with an average of(6.24±0.98);ODI was 26-39,with an average of(31.8±3.4)(sex performance was not included).All patients underwent Endo-ULBD,and were followed up for more than 1 year.Lumbar X-ray,computed tomography(CT)and magnetic resonance imaging(MRI)were performed 2 or 3 days after operation.MacNab’s outcome assessment and perioperative complications were also documented.On the 2nd to 3rd day after operation,the lumbar spine MRI or CT were reviewed to evaluate the laminoplasty,dural sac and bilateral nerve root decompression.Follow-up was performed at 2 days,3 months,6 months,and 12 months after surgery,and the recovery of lumbar spine function was evaluated by modified MacNab.Results No patients suffered postoperative infection,serious nerve root injury or complications including lumbar instability in this study.VAS and ODI after operation were significantly lower than preoperative results(P<0.01).Complete follow-up data were obtained for all 50 cases,and the follow-up was 12 to 16 months with an average of(13.0±0.8)months.VAS of lumbar and leg pain and the ODI of lumbar spine function at each follow-up were lower than those in the previous follow-up,and the differences were statistically significant(P<0.01).MacNab score at 12 months after operation or at the last follow-up:excellent in 10 cases,good in 36 cases,fair in 4 cases,with an excellent and good rate of 90.0%.Conclusions Endo-ULBD is a minimally invasive,efficient,and safe alternative for the treatment of lumbar spinal stenosis.