脊柱内镜可视环锯技术治疗退行性腰椎椎间孔狭窄症

Application of Endoscopic Visible Ring Saw in the Treatment of Degenerative Lumbar Foraminal Stenosis

目的探讨脊柱内镜可视环锯技术治疗退行性腰椎椎间孔狭窄症的临床疗效。方法回顾性分析2019年10月~2020年12月脊柱内镜可视环锯技术治疗退行性腰椎椎间孔狭窄症75例的临床资料,年龄77~89岁,平均86.5岁。均有单侧下肢神经根性症状。均为单责任节段椎间孔狭窄,责任节段L_(4/5)15例,L_(5)/S_(1)60例。术后1个月复查腰椎X线和CT,术前及术后1、6及12个月评估腿痛视觉模拟评分(Visual Analogue Scale,VAS)和Oswestry功能障碍指数(Oswestry Disability Index,ODI),术后12个月按照腰椎改良MacNab标准评价手术疗效。结果手术时间(50.3±6.5)min,术中无血管及神经损伤等并发症。术后1个月腰椎过伸过屈侧位X线显示椎体间水平位移值、成角位移值较术前差异无统计学意义(P>0.05),CT显示椎间孔最大宽度及面积较术前明显增加(均P=0.000),椎间孔最大高度较术前差异无统计学意义(P>0.05)。术后12个月按改良MacNab标准,优48例,良22例,可4例,差1例,优良率93.3%。术后1、6、12个月腿痛VAS评分和ODI较术前明显改善(均P=0.000)。结论脊柱内镜可视环锯技术治疗退行性腰椎椎间孔狭窄症的疗效满意,椎间孔扩大明显,神经减压充分,且不影响腰椎稳定性。

Objective To investigate the clinical effect of endoscopic visual ring saw in the treatment of degenerative lumbar foraminal stenosis.Methods Clinical data of 75 patients with degenerative lumbar foraminal stenosis treated by endoscopic visual ring saw from October 2019 to December 2020 were retrospectively analyzed.The patients aged 77-89 years old(mean,86.5 years old).All the patients had unilateral radiculopathy and single-responsible segmental foraminal stenosis,including 15 cases of responsible segment L_(4/5) and 60 cases of responsible segment L_(5)/S_(1).Lumbar radiography and CT were reviewed at 1 month after surgery.The Visual Analogue Scale(VAS)and Oswestry Disability Index(ODI)were assessed before surgery and at 1,6 and 12 months after surgery.The lumbar modified MacNab criteria were used to evaluate the curative effect at 12 months after surgery.Results The operation time was(50.3±6.5)min.There were no complications such as vascular or nerve injury.At 1 month after surgery,lateral X-ray of lumbar hyperextension and flexion showed no statistically significant difference in the horizontal and angular displacement values between the vertebral bodies compared with the preoperative values(P>0.05).Lumbar CT showed that the maximum width and area of the foramina were significantly increased compared with the preoperative values(all P=0.000),and the maximum height of the foramina had no statistically significant difference compared with the preoperative values(P>0.05).At 12 months after operation,according to the modified MacNab criteria,48 cases were excellent,22 cases were good,4 cases were fair,and 1 case was poor,the excellent and good rate being 93.3%.The VAS scores of leg pain and ODI at 1,6 and 12 months after surgery were significantly improved compared with those before surgery(all P=0.000).Conclusion Endoscopic visual ring saw technique is satisfactory in the treatment of degenerative lumbar foraminal stenosis,with obvious foraminal enlargement,sufficient nerve decompression,and no influence on the stability of the lumbar spine.