全内镜大通道单侧入路双侧减压治疗老年单节段腰椎管狭窄症的早期疗效

Early outcomes of unilateral laminectomy for bilateral decompression under full endoscopic with large portal for single-segment lumbar spinal stenosis in the elderly

中文关键词:  腰椎管狭窄症  脊柱全内镜  单侧入路双侧减压  老年

英文关键词:Lumbar spinal stenosis  Full endoscopic  Unilateral approach  Bilateral decompression  Elderly

中文摘要:

  【摘要】 目的：评估脊柱全内镜大通道下单侧入路双侧减压（unilateral laminotomy for bilateral decompression，ULBD）治疗老年单节段腰椎管狭窄症的早期临床效果。方法：回顾性分析我院2018年7月~2020年7月采用全内镜大通道下ULBD治疗的37例单节段腰椎管狭窄症患者。其中男17例，女20例；年龄60~78岁（66.8±4.9岁）；手术节段：L3-4 7例，L4-5 20例，L5-S1 10例。收集患者手术资料及术中并发症情况。术前及术后1周、3个月、1年采用疼痛视觉模拟评分（visual analog scale，VAS）评价腰腿痛，Oswestry功能障碍指数（Oswestry disability index，ODI）评价下肢功能。术后1年采用MacNab标准对临床疗效进行评价。结果：所有患者手术顺利，手术时间75~155min（113.7±19.4min），术中出血量10~50ml（26.5±9.4ml），住院天数5~7d（5.5±0.7d）。术中发生1例硬膜囊撕裂，行胶原蛋白海绵封闭后严格卧床休息1周，患者未出现明显临床症状，伤口愈合良好。术前、术后1周、3个月、1年的腰痛VAS评分分别为5.4±0.5分、2.4±0.6分、1.0±0.5分、0.4±0.5分，腿痛VAS评分分别为7.3±0.5分、2.7±0.5分、1.3±0.5分、0.7±0.6分，ODI分别为（78.6±2.3）%、（26.0±4.1）%、（17.4±2.2）%、（10.7±2.0）%。术后各时间点腰腿痛VAS评分、ODI均较术前显著改善，差异具有统计学意（P<0.001）。术后各时间点间两两比较差异均有统计学意义（P<0.001）。术后1年MacNab标准优21例，良13例，可3例，优良率91.89%。结论：脊柱全内镜大通道下ULBD治疗老年单节段腰椎管狭窄症的早期临床效果较好，但远期疗效需进一步随访。

英文摘要:

  【Abstract】 Objectives: To investigate the early outcomes of unilateral laminectomy for bilateral decompression(ULBD) under full endoscopic with large portal for single-segment lumbar spinal stenosis in the elderly. Methods: 37 patients with single-segment lumbar spinal stenosis treated via ULBD under full endoscopic with large portal from July 2018 to July 2020 in our hospital were retrospectively analyzed. There were 17 males and 20 females, averaged 66.8±4.9(60-78) years. 7 cases were operated at L3-4, 20 cases at L4-5, and 10 cases at L5-S1. Data of patients and intraoperative complications were collected. The pain visual analog scale(VAS) was used to evaluate the low back pain and leg pain, and the Oswestry disability index(ODI) was used to evaluate the lumbar function recorded before operation, at 1 week, 3 months, and 1 year after operation. One year after operation, the clinical curative effect was evaluated by MacNab standard. Results: Of all the patients, the average operative time was 113.7±19.4min(75-155min), intraoperative blood loss was 26.5±9.4ml(10-50ml), and the length of hospitalization was 5.5±0.7 days(5-7 days). 1 case of dural sac tear occurred during operation, and the patient was strictly bedridden for one week after collagen sponge closure. The patient did not show any obvious clinical symptoms, and the wound healed well. The preoperative, one week, three months and one year postoperative VAS scores for low back pain were 5.4±0.5, 2.4±0.6, 1.0±0.5 and 0.4±0.5, respectively, and the VAS scores for leg pain were 7.3±0.5, 2.7±0.5, 1.3±0.5 and 0.7±0.6, respectively, and the ODI were (78.6±2.3)%, (26.0±4.1)%, (17.4±2.2)%, and (10.7±2.0)%, respectively. The VAS score of low back pain and leg pain and ODI score at each time point after operation were significantly improved when compared with those before operation(P<0.001), and the values at each time point after operation were significantly different when compared pairwise(P<0.001). The clinical efficacy was evaluated 1 year after surgery using MacNab criteria, and 21 cases were classified as excellent, 13 cases as good, 3 cases as acceptable and 0 cases as poor, with an excellent rate of 91.89%. Conclusions: The early outcomes of ULBD under full endoscopic with large portal for single-segment lumbar spinal stenosis in the elderly are good, but further follow-up is required for long-term outcomes.