经皮大通道脊柱内镜治疗老年腰椎管狭窄症的初步疗效

Preliminary Effect of Percutaneous Large Channel Spinal Endoscopy in the Treatment of Elderly Lumbar Spinal Stenosis

目的探讨经皮大通道脊柱内镜下治疗老年单节段腰椎管狭窄症的近期疗效。方法回顾分析2020年1月至2021年1月新疆维吾尔自治区人民医院脊柱二科,采用经皮大通道脊柱内镜治疗老年单节段退变性腰椎管狭窄症24例,其中男性13例,女性11例;年龄60~84岁,平均(72.6±4.3)岁。责任节段包括:L_(3~4)节段4例,L_(4~5)节段12例,L 5S 1节段8例。腰椎管狭窄中央型6例,侧隐窝型12例,中央型合并侧隐窝型6例。手术前和手术后随访时采用疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)对患者进行评估,改良MacNab评价患者的临床疗效。结果24例患者手术均顺利完成,手术时间为55~86 min,平均(65.3±10.4)min;术中透视3~5次,平均(3.2±0.2)次;手术切口长约10 mm;住院时间3~7 d,平均(4.1±0.3)d。术中1例患者发生硬膜囊撕裂,1例患者发生患侧肢体疼痛过敏,经对症治疗后均无明显后遗症。24例患者均获随访,随访时间12~24个月,平均(16.3±2.1)个月。术后腰、腿痛VAS评分和ODI评分相对于手术前比较差异均有统计学意义(P<0.05)。手术后每个时间点之间比较差异均有统计学意义(P<0.05)。术后12个月时改良MacNab评价疗效,优18例,良3例,可3例,优良率为87.5%。结论采用经皮大通道脊柱内镜治疗老年单节段腰椎管狭窄症创伤小、出血少、住院时间短、术后康复快、近期疗效好。

Objective To explore the recent efficacy of percutaneous large channel spinal endoscopy in the treatment of single segment lumbar spinal stenosis in the elderly.Methods From January 2020 to January 2021,24 elderly patients with single level degenerative lumbar spinal stenosis were treated by percutaneous large channel spinal endoscopy in our department,including 13 males and 11 females.The average age was 60~84 years(72.6±4.3).The section of responsible included 4 cases at L_(3~4) segment,12 cases at L_(4~5) segment,and 8 cases at L 5S 1 segment.Lumbar spinal stenosis patients included 6 cases of central type,12 cases of lateral recess type,6 cases of central type combined with lateral recess type.Visual analogue scale(VAS)and Oswestry disability index(ODI)were used to evaluate the patients before and after surgery,and MacNab was improved to evaluate the clinical efficacy of patients.Results The 24 patients in this group successfully completed the operation.The operation time was 55~86 min(65.3±10.4)min.Tthe intraoperative fluoroscopy was 3~5 times(3.2±0.2)times.The length of the surgical incision was about 10 mm,and the hospital stay was 3~7 days(4.1±0.3)days.Dural sac tear occurred in 1 patient during operation.One patient had pain and allergy in the affected limb.There were no obvious sequelae after symptomatic treatment.The patients were followed up for 12 to 24 months(16.3±2.1)months.The VAS score and ODI score of lumbar and leg pain after surgery were statistically different from those before surgery(P<0.05).There was significant difference between each time point after operation(P<0.05).At 12 months after operation,the modified MacNab evaluation showed that the curative effect was excellent in 18 cases,good in 3 cases,and fair in 3 cases,with an excellent and good rate of 87.5%.Conclusion Percutaneous large channel spinal endoscopy for the treatment of elderly single segment lumbar spinal stenosis has the advantages of less trauma,less bleeding,short hospital stay,quick postoperative recovery,and good short-term effect.