全内镜下可视化经椎弓根上切迹入路手术治疗腰椎侧隐窝狭窄症的疗效分析

Clinical analysis of lumbar lateral recess stenosis with the full-endoscopic visualized decompression via a superior vertebral notch approach

中文关键词:  侧隐窝狭窄症  经椎弓根上切迹入路  全内镜  可视化

英文关键词:Lateral recess stenosis  Superior vertebral notch approach  Full-endoscopic  Visualized

中文摘要:

  【摘要】 目的：分析全内镜（full-endoscopic，FE）下可视化经椎弓根上切迹入路手术治疗腰椎侧隐窝狭窄症的临床疗效。方法：收集2016年6月～2017年12月在我院采用FE下可视化经椎弓根上切迹入路手术治疗的96例腰椎侧隐窝狭窄症患者的临床资料，其中男性62例，女性34例，年龄38~68岁（51.4±13.3岁）；L3/4 8例，L4/5 62例，L5/S1 26例。术前腰、腿痛视觉模拟评分（visual analogue scale，VAS）分别为0～5（3.8±1.6）、3～7（5.2±1.0）；腰椎Oswestry功能障碍指数（ODI）为38％~65％[（53.0±9.1）%]；手术节段侧隐窝角和前后径分别为17.6°±1.4°和2.3±0.2mm。术后完成至少2年随访。记录患者手术时间、术中透视次数、住院时间和围手术期并发症，在术后1周的CT/MRI横断面上测量手术节段侧隐窝角和前后径；术后1周、3个月、1年和末次随访时行下肢痛和腰痛VAS评分、ODI评定，并进行统计学分析；末次随访时参照改良MacNab标准评价临床疗效。结果：患者均顺利完成手术，手术时间55.8±14.6min，术中透视次数7.2±2.5次，住院3.7±1.9d。1例术后出现短暂性神经根麻痹，保守治疗1周内症状消失；6例术后症状残留，4例术后症状未改善。至末次随访时共有6例再次后路行翻修手术。术后侧隐窝角和前后径分别为39.5°±4.2°和6.2±0.4mm，均较术前显著性增加（P<0.001）。所有患者均获得随访，随访时间24～32（26.6±5.6个月），术后1周、3个月、1年和末次随访时下肢痛和腰痛VAS评分、ODI均较术前显著性改善（P<0.05）。末次随访时改良Macnab标准评定：优32例，良54例，一般6例，差4例，优良率为89.6%。结论：FE下可视化经椎弓根上切迹入路手术治疗腰椎侧隐窝狭窄症安全、有效，能够获得良好的短期临床疗效，但需要严格选择适应证，以免影响术后临床症状改善。

英文摘要:

  【Abstract】 Objectives: To evaluate the clinical outcomes and key points of the full-endoscopic(FE) visualized decompression via a superior vertebral notch approach for the treatment of lumbar lateral recess stenosis. Methods: 96 cases with lumbar lateral recess stenosis that underwent the FE visualized decompression via a superior vertebral notch approach from June 2016 to December 2017 in our hospital were enrolled. There were 62 males and 34 females, with an average age of 51.4±13.3 years(38-68 years). The preoperative visual analog scale(VAS) scores of low back pain and leg pain were 0-5(3.8±1.6) and 3-7(5.2±1.0), respectively. The preoperative Oswestry disability index(ODI) was 38％-65％[(53.0±9.1)%]. The preoperative angle and anteroposterior diameter of the lateral recess were 17.6°±1.4° and 2.3±0.2mm, respectively. All patients were followed up for 2 years at least. The VAS scores of low back pain and leg pain, and lumbar ODI were evaluated and analyzed at 1 week, 3 months, 1 year and final follow-up postoperatively. The surgical effectiveness was assessed according to the modified MacNab criteria at final follow-up. Results: 96 cases were successfully completed the operation. The average operation time was 55.8±14.6min; the average times of radiation was 7.2±2.5; the average length of hospital stay was 3.7±1.9 days. One case occurred temporary paralysis who recovered after a conservative treatment within 1 week. 6 cases remained residual symptoms, and 4 cases didn′t show any improvement after surgery. 6 cases had to undergo revision surgery finally. The postoperative angle and anteroposterior diameter of the lateral recess were 39.5°±4.2° and 6.2±0.4mm, significantly increased comparing with pre-operation(P<0.01). The postoperative VAS scores for low back and leg pain, as well as the ODI at 1 week, 3 months, 1 year and final follow-up were obviously improved when compared with pre-operation(P<0.05). All patients were followed up, the follow-up time was 24－32 months(26.6±5.6 months). Based on the modified MacNab scores at final follow-up, 32 cases were classified as excellent; 54 cases were good; 6 cases were fair; 4 cases were poor, with 89.6% of the satisfactory rate. Conclusions: The FE visualized decompression via a superior vertebral notch approach is an effective and safe surgery for lumbar lateral recess stenosis and is able to achieve satisfactory short-term results. However, the indications need to be strictly selected, to avoid affecting the improvement of clinical outcomes.