单侧双通道内镜减压治疗老年腰椎退行性侧凸伴椎管狭窄症

Unilateral biportal endoscopy decompression for treatment of degenerative lumbar scoliosis with spinal stenosis

目的探讨单侧双通道内镜减压治疗老年腰椎退行性侧凸伴椎管狭窄症的疗效。方法采用单侧双通道内镜减压治疗20例老年腰椎退行性侧凸伴椎管狭窄症患者。记录手术情况、并发症发生情况,比较手术前后疼痛VAS评分、ODI评分、Cobb角,采用改良MacNab标准评价临床疗效。结果患者均获得随访,时间6~12(9.8±1.4)个月。手术时间95~205(149.8±43.2)min,术后住院时间4~9(4.8±2.4)d。2例硬膜囊撕裂,2例因手术节段与责任节段不一致术后症状缓解不明显;其余患者未发生神经损伤、肌力下降、切口感染或不愈合等手术并发症。疼痛VAS评分及ODI评分术后第2天、1个月、3个月、6个月均较术前改善(P<0.05),Cobb角术后第2天、1个月、3个月、6个月与术前比较差异均无统计学意义(P>0.05)。末次随访时,采用改良MacNab标准评价临床疗效:优10例,良6例,可4例,优良率16/20。结论单侧双通道内镜减压治疗老年腰椎退行性侧凸伴椎管狭窄症早期疗效满意,具有微创、椎管减压充分、不影响脊柱稳定性等优势。

Objective To investigate the effect of unilateral biportal endoscopy decompression in the treatment of elderly lumbar degenerative scoliosis with spinal stenosis.Methods The 20 elderly patients who suffered from lumbar degenerative scoliosis with spinal stenosis were treated with unilateral biportal endoscopy decompression.The surgical situation,pain VAS,ODI score and Cobb angle before and after surgery were recorded.The modified MacNab standard was used to evaluate the clinical effect.Results All patients were followed up for 6~12(9.8±1.4)months.The operative time was 95~205(149.8±43.2)min,and the postoperative hospitalization time was 4~9(4.8±2.4)d.There were 2 cases of dural sac tear;2 cases of postoperative symptoms were not significantly relieved due to the disunity of the operative segment and the responsible segment.The other patients did not have nerve injury,muscle strength decline,incision infection or nonunion.At 2 d,1,3,6 months after surgery,the pain VAS and ODI scores were significantly improved,compared with the preoperation(P<0.05),while there was no significant difference in Cobb angle(P>0.05).At the last follow-up,the modified MacNab standard was used to evaluate the clinical effect:10 cases were excellent,6 cases were good,4 cases were fair,and the excellent and good rate was 16/20.Conclusions Unilateral biportal endoscopy decompression is effective in the treatment of elderly lumbar degenerative scoliosis with spinal stenosis,which has the advantages of minimally invasive,sufficient decompresion of spinal canal and without influencing the stability of the spine.