显微内窥镜下改良工作通道单侧入路双侧减压治疗退变性腰椎管狭窄症

Treatment of degenerative lumbar spine stenosis by modified unilateral approach for bilateral decompression under microendoscope

中文关键词:  腰椎  椎管狭窄症  显微内窥镜  改良工作通道

英文关键词:Lumbar vertebrae  Spine stenosis  Microendoscope  Modified channel

中文摘要:

  【摘要】 目的：探讨显微内窥镜下应用改良工作通道单侧入路双侧减压治疗退变性腰椎管狭窄症的可行性及疗效。方法：2003年9月~2008年12月应用脊柱显微内窥镜配置改良工作通道行单侧开窗双侧潜式减压中央椎管及神经根管治疗退变性腰椎管狭窄症217例，其中单节段163例，双节段54例。术后行CT和X线片检查，并按Nakai标准评定疗效。结果：手术时间25~95min，平均48±13min；术中出血25~180ml，平均37±9ml；切口长度1.8～2.4cm，平均2.2±0.2cm。术中硬脊膜撕裂2例，予明胶海绵填塞，并严格卧床2周，术后无脑脊液漏；定位错误1例，术中予以纠正；无神经损伤、术后感染等手术并发症。术后CT显示椎管减压充分。随访3～24个月，平均14个月，末次随访时按Nakai标准评定，优134例，良63例，可16例，差4例，优良率为90.8％；无腰椎不稳。结论：显微内窥镜下应用改良工作通道单侧入路双侧减压治疗退变性腰椎管狭窄症创伤小、并发症少、疗效确切，是治疗该疾病较理想的微创手术。

英文摘要:

  【Abstract】 Objective：To evaluate the feasibility and clinical efficacy of the treatment of lumbar spine stenosis by modified unilateral approach for bilateral decompression under microendoscope.Method：217 cases with degenerative lumbar spine stenosis from September 2003 to December 2008 were treated by modified unilateral approach for bilateral decompression of central spinal canal and nerve root canal under microendoscope.Among them laminectomy of one segment was done in 163 cases，two segments were done in 54 cases.After surgery，the routine radiograph were carried out and the Nakai criterion was used for assessment.Result：The mean operative time was 48±13min（range，25 to 95min），the average blood loss was 37±9ml（range，25 to 180ml），the average skin incision length was 2.2±0.2cm（1.8 to 2.4cm）.2 cases had dural matter tearing，which healed after filling with gelatin foam and 2 weeks bed rest，after that no cerebrospinal fluid leakage was noted after surgery.Mislocation was noted in 1 case.No nerve inury and postoperative infection occurred.Postoperative CT scan demonstrated complete decompression of the central spinal canal and nerve root canal.All patients were followed-up for an average of 14 months（range，3 months to 24 months）.The Nakai criterion at final follow-up showed clinical excellent in 134 cases，good in 63 cases，fair in 16 cases and worse in 4 cases，with the excellent and good rate of 90.8%.No lumbar spine instability was noted.Conclusion：Treatment of degenerative lumbar spine stenosis by modified unilateral approach for bilateral decompression under microendoscope has the merit of minimal invasive，less complications and reliable therapeutical effect.