全可视脊柱内镜椎间孔再造手术治疗退行性L_(5)S_(1)椎间孔狭窄症

Fully visual spinal endoscopic foraminal reconstruction for L_(5)S_(1)degenerative foraminal stenosis

目的观察采用全可视脊柱内镜椎间孔再造手术治疗退行性L_(5)S_(1)椎间孔狭窄症的临床疗效。方法回顾性分析自2019-11—2020-11采用全可视脊柱内镜椎间孔再造手术治疗的60例退行性L_(5)S_(1)椎间孔狭窄症,手术采用局部浸润麻醉,使用Endo-surgy standard手术器械套装,可视内镜外环锯切除S_(1)上关节突尖部、部分肩部腹侧及部分基底部腹侧骨质,进行椎间孔扩大成形,之后用髓核钳咬除椎间孔内增生肥厚的黄韧带,显露L5出口神经根及S_(1)行走神经根进行椎间孔减压。结果本组手术时间为(49.58±6.74)min,术中出血量为(19.83±6.23)mL,住院时间为(3.05±0.65)d。术后腰椎CT显示椎间孔区减压充分,腰椎过伸过屈侧位X线片显示腰椎稳定性良好,未出现血管、神经损伤。60例均获得随访,随访时间13~25个月,平均18.5个月。术后1、6、12个月疼痛VAS评分、ODI指数较术前明显改善,差异有统计学意义(P<0.05)。术后6个月根据腰椎功能MacNab标准评定疗效:优40例,良16例,可3例,差1例。结论全可视脊柱内镜椎间孔再造手术治疗退行性L_(5)S_(1)椎间孔狭窄症的短期疗效确切,是一种安全、有效的微创手术。

Objective To observe the clinical efficacy of foraminal reconstruction with full visual spinal endoscopy for L_(5)S_(1)de-generative foraminal stenosis.Methods A retrospective analysis was performed on the clinical data of 60 patients with L_(5)S_(1)degenerative foraminal stenosis who underwent foraminal reconstruction by total visual spinal endoscopy from November 2019 to November 2020.Local invasive anesthesia was performed using Endo-surgy standard surgical instrument set.The apical bone of S_(1)superior articular process,part of the ventral shoulder and part of the ventral base were removed by visual mirror ex-ternal ring saw,and the foraminal enlargement reconstruction was performed.After that,nucleus pulposus forceps were used to remove the hypertrophic ligamenta flavum in the foramina,expose the L_(5)exit nerve root and S1 walking nerve root,and decom-press the foramina.Results The operation time was(49.58±6.74)min,the intraoperative blood loss was(19.83±6.23)mL,and the length of hospital stay was(3.05±0.65)d.Postoperative CT examination of the lumbar spine showed sufficient decom-pression in the foraminal area,and lateral radiographs of lumbar hyperextension and flexion showed good stability of the lumbar spine,with no vascular or nerve damage.All 60 cases were followed up for 13 to 25 months(mean 18.5 months).According to the MacNab standard of lumbar function,40 cases were excellent,16 cases good,3 cases fair,and 1 case was poor.The pain VAS score and ODI index at 1,6 and 12 months after surgery were significantly improved compared with those before surgery,with statistical significance(P<0.05).Conclusion Foraminal reconstruction with fully visual spinal endoscopic is a safe and effective minimally invasive surgery for the treatment of L_(5)S_(1)degenerative foraminal stenosis,and the definite shortterm efficacy can be obtained.