大通道全内镜下单侧入路双侧椎管减压治疗退变性腰椎管狭窄症

Treatment of degenerative lumbar spinal canal stenosis with unilateral approach and bilateral decompression under large-channel full endoscopy

目的探讨大通道全内镜下单侧入路双侧椎管减压治疗退变性腰椎管狭窄症的临床疗效。方法采用大通道全内镜下单侧入路双侧椎管减压治疗17例退变性腰椎管狭窄症患者。记录手术时间、术中出血量及并发症发生情况,采用疼痛VAS评分评估腰腿痛程度,采用ODI评价腰椎功能情况,根据改良MacNab评定标准评价疗效。结果手术时间100~380(169.53±72.73)min,术中出血量20~150(39.41±35.44)ml。1例术中硬膜囊撕裂。未发生椎间隙感染、神经损伤、血管损伤、椎管内血肿等并发症。患者均获得随访,时间7~24个月。术后3 d、1个月、3个月及末次随访时疼痛VAS评分、ODI均较术前明显改善(P<0.05)。末次随访时根据改良MacNab评定标准评价疗效:优7例,良9例,可1例,优良率16/17。结论大通道全内镜下单侧入路双侧椎管减压治疗退变性腰椎管狭窄症创伤小,并发症少,疗效好。

Objective To investigate the clinical effect of large-channel full endoscope-assisted bilateral decompression for degenerative lumbar spinal stenosis via unilateral approach.Methods The 17 cases of degenerative lumbar spinal canal stenosis were treated by unilateral approach and bilateral decompression under large-channel full endoscopic.The operation time,intraoperative blood loss and complications were recorded.The degree of lumbocrural pain was evaluated by pain visual analogue score(VAS),the lumbar function was evaluated by the Oswestry dysfunction index(ODI),the curative effect was evaluated according to the modified MacNab evaluation standard.Results The operative time was 100~380(169.53±72.73)min,and the intraoperative blood loss was 20~150(39.41±35.44)ml.There was 1 case of intraoperative dural sac tear;and no complications such as intervertebral space infection,nerve injury,blood vessel injury and intraspinal hematoma occurred.All patients were followed up for 7~24 months.The pain VAS and ODI were significantly improved at 3 d,1 month,3 months after operation and the last follow-up(P<0.05).At the last follow-up,according to the modified MacNab evaluation standard,7 cases were excellent,9 good,1 fair,the excellent and good rate was 16/17.Conclusions The treatment of degenerative lumbar spinal canal stenosis by large-channel full endoscopic bilateral decompression with unilateral approach has less trauma,fewer complications and good curative effect.