精准定位经皮全内镜椎板开窗减压术治疗腰椎管狭窄症

Percutaneously full endoscopic decompressive laminectomy with precise localization for the treatment of lumbar spinal stenosis

目的:应用精准定位全内镜下椎板开窗减压术式(full endoscopic fenestration,FE-FE)治疗腰椎管狭窄症(lumbar spinal stenosis,LSS),并探讨其临床实用性及术后疗效。方法:参照传统开放手术中椎板开窗减压术,应用操作水介质椎板间脊柱内镜技术完成腰椎管减压。对2016年6月至2017年6月接受FE-FE手术治疗的37例LSS患者进行回顾性分析,其中男19例,女18例,年龄55~83(67.1±18.9)岁。记录手术前后视觉模拟评分(VAS)、腰椎疾患JOA评分、Oswestry功能残障量表(ODI)及SF-36生活质量量表评定分值,观察患者自觉疼痛及神经功能恢复情况,并根据JOA评分改善率对临床疗效进行评定。结果:37例患者均获得随访,时间8~24(13.7±6.1)个月。术后VAS、JOA、ODI及SF-36分值均较术前有明显改善(P<0.05)。根据JOA评分改善率进行疗效评估,术后6个月优17例,良13例,可5例,差2例;末次随访优19例,良13例,可4例,差1例。术后影像学显示椎管容积明显扩大,临床症状有满意的改善,腰腿疼痛缓解、生活质量提高、社会活动适应性增加,无严重并发症发生。结论:精准定位是全内镜下完成椎板开窗减压的关键,FE-FE治疗LSS创伤小、疗效肯定、安全可靠,具有较广阔应用前景。

Objective:To explore the feasibility of full endoscopic fenestration(FE-FE)via interlaminar approach for the treatment of lumbar spinal stenosis(LSS),and mean while,to analyze the related practicability and clinical outcome.Methods:Referring to the traditional laminectomy and decompression,the lumbar spinal canal decompression was performed by using the water-medium spinal endoscopy(named FE-FE technique).Thirty-seven patients with LSS treated by FE-FE technique were retrospectively analyzed.There were 19 males and 18 females,aged from 55 to 83 years old with an average of(67.1±18.9)years.Visual analogue scale(VAS),Japanese Orthopaedic Association Scores(JOA),Oswestry Disability Index(ODI)and 36-Item Short-Form Health Survey(SF-36)were recorded.The patient’s conscious pain and recovery of neurological function were observed,and the clinical efficacy was evaluated according to the improvement rate of JOA score.Results:All 37 patients were followed up for 8 to 24 months with an average of(13.7±6.1)months.The postoperative follow-up and clinical evaluation for conscious pain and neurological function recovery showed that VAS,JOA,ODI and SF-36 scores were significantly improved compared with those before surgery(P<0.05).According to the improvement rate of JOA score to evaluate the clinical effects,at 6 months after opertion,the results were excellent in 17 cases,good in 13 cases,fair in 5 cases,and poor in 2 cases;and the last follow-up,the results were excellent in 19 cases,good in 13 cases,fair in 4 cases,and poor in 1 case.Postoperative imaging showed significant expansion of spine canal volume,and the followed-up clinical symptoms were improved satisfactorily,with the relief of lumbago and leg pain,improvement of daily life quality,and increased adaptability to social activities and no serious complications.Conclusion:Precise localization is the key to complete the canal decompression under full endoscopic surgery.FE-FE technique can effectively enlarge the narrow lumbar canal with less trauma,positive efficacy,safety and reliability.FE-FE has a broad application prospect though large cases and multi-center studies need to be further carried out.