下关节突锚定技术在内镜腰椎管减压术中的应用

Application and Therapeutic Observation of Lower Articular Process Anchoring Technique in Endoscopic Lumbar Spinal Canal Decompression Surgery

目的:观察环锯下关节突锚定技术在单孔同轴脊柱内镜下单侧椎板间入路双侧椎管减压(Endo-ULBD)治疗腰椎管狭窄症(LSS)中的安全性及有效性。方法:回顾应用镜下环锯下关节突锚定技术治疗腰椎管狭窄症患者33例,比较术前、术后疼痛视觉模拟量表(VAS)评分及Oswestry功能障碍指数(ODI)评分,观察术后并发症,采用MacNab标准进行疗效评价。结果:所有患者均顺利完成手术并得到随访,手术时间为67~115 min,1例患者术中神经根外膜损伤;术后随访VAS评分和ODI评分与术前比较,差异均有统计学意义(P<0.05)。术后12个月采用MacNab标准评价:优25例,良5例,可3例,优良率为90.9%。结论:环锯下关节突锚定技术在单孔同轴脊柱内镜下单侧椎板间入路双侧椎管减压治疗腰椎管狭窄症中操作简单,安全有效,值得临床推广应用。

Objective:Observing the safety and effectiveness of the lower articular process anchoring technique under a single hole coaxial endoscope in the treatment of lumbar spinal stenosis(LSS)through percutaneous endoscopic unilateral laminotomy and bilateral decompression(Endo-ULBD).Methods:A retrospective study was conducted on 33 patients with LSS treated with arthroscopic circular lower articular process anchoring technique.The preoperative and postoperative pain visual analogue scale(VAS)scores and Oswestry disability index(ODI)scores were compared,and postoperative complications were observed.The efficacy was evaluated using the MacNab standard.Results:All patients successfully completed the surgery and received follow-up,with a surgical duration of 67115 min.One patient had intraoperative nerve root outer membrane injury.The postoperative follow-up VAS score and ODI score were statistically significant compared to preoperative results(P<0.05).After 12 months of surgery,MacNab criteria were used to evaluate 25 cases as excellent,5 cases as good,and 3 cases as fair,with an excellent and good rate of 90.9%.Conclusion:The lower articular process anchoring technique under circular sawing is simple to operate,safe and effective in Endo-ULBD treatment of LSS,and is worthy of clinical promotion and application.