侧路椎间孔镜技术治疗腰椎管狭窄症的有效性和安全性

Efficacy and safety of lateral percutaneous transforaminal endoscopic discectomy in treatment of lumbar spinal stenosis

目的探讨侧路椎间孔镜技术治疗腰椎管狭窄症的有效性及安全性。方法观察2016年3月至2017年8月广西中医药大学附属瑞康医院脊柱外科收治的同组医生采用经椎间孔入路治疗严重影响其生活的L4～5单节段腰椎管狭窄症患者60例。出院时复查腰椎磁共振成像、CT并根据改良Mac Nab疗效评定优良率。比较患者入院前及出院时日本骨科协会(JOA)评分。结果 60例患者术中均无硬膜囊损伤等并发症,出院时根据改良Mac Nab疗效评定为优10例,良38例,可9例,差3例,优良率80%。出院时60例患者JOA评分明显优于入院时[(19. 6±4. 8)分比(8. 3±1. 2)分,t=-24. 19,P <0. 05]。结论椎间侧路孔镜技术治疗腰椎管狭窄症是安全的,对于大部分患者近期临床效果较好,对于少数患者疗效不佳。

Objective To explore the efficacy and safety of lateral percutaneous transforaminal endoscopic discectomy in treatment of lumbar spinal stenosis. Methods Sixty patients with L4-5 single segment lumbar spinal stenosis undergoing lateral percutaneous transforaminal endoscopic discectomy from March 2016 to August 2017 in Ruikang Hospital Affiliated to Guangxi University of Traditonal Chinese Medicine were enrolled. Curative effect of operation was assessed by magnetic resonance imaging,CT,modified MacNab criteria and Japanese Orthopedic Association( JOA) score. Results There was no dural injury in all patients during operation. According to the modified MacNab criteria,10 cases had good curative effect;38 cases had satisfactory curative effect;9 cases had adequate curative effect and 3 cases had unsatisfactory curative effect;the good-to-satisfactory rate was 80%. The JOA score at discharge was significantly higher than that at admission (( 19. 6 ± 4. 8) vs( 8. 3 ± 1. 2),t =-24. 19,P < 0. 05)Conclusion Lateral percutaneous transforaminal endoscopic discectomy is safe and effective in the treatment of lumbar spinal stenosis.