经皮椎间孔及椎板间联合入路内窥镜下行腰椎管狭窄减压术的初步报告

Treatment of lumbar spinal stenosis by using percutaneous coaxial endoscopic combined transforaminal and interlaminar approaches: a primary report

中文关键词:  微创  内窥镜  腰椎管狭窄  经椎间孔入路  经椎板间入路

英文关键词:Minimally invasive  Endoscopy  Lumbar spinal stenosis  Transforaminal approach  Interlaminar approach

中文摘要:

  【摘要】 目的：探讨经皮椎间孔及椎板间联合入路内窥镜下减压治疗以腰椎管侧隐窝狭窄为主要表现的混合性腰椎管狭窄症的临床疗效。方法：2012年6月～2015年1月收治混合性腰椎管狭窄症患者13例，男9例，女4例，平均年龄65±11.6岁（46~86岁），病程4.7±2.9年，患者均有明确腰腿痛病史并伴单侧下肢神经症状及体征，神经源性间歇性跛行均小于500m。术前评估行全麻开放手术风险较高，均采用局麻下联合椎间孔及椎板间入路行内窥镜下减压术治疗。术前及末次随访时应用视觉模拟评分（visual analogue scale，VAS）和Oswestry功能障碍指数（Oswestry disability index，ODI）对患者疼痛及腰部功能进行评价，应用Nakai标准评价临床疗效。结果：全部手术在局麻下顺利完成，手术时间90～140min，平均107.7±16.4min。术中并发神经根外膜撕裂1例，椎管内出血1例，经对症治疗后无明显后遗症状。平均住院4.7±1.2d（3～7d），平均随访时间19.6±9.0个月（9～40个月）。末次随访时腰部及下肢VAS评分由术前的4.6±0.8分和4.7±0.9分降至1.8±0.9分和1.0±0.7分，ODI由术前的（32.7±6.9）%降至（10.5±3.0）%，统计学上有显著性差异（P＜0.05）。应用Nakai评价的优良率为76.9%（优6例，良5例，可2例，差1例）。结论：局麻下联合椎间孔及椎板间入路行内窥镜下减压术治疗混合性腰椎管狭窄症安全有效，恢复快，住院时间短，对于麻醉风险高的患者可以作为一种有效的微创治疗腰椎管狭窄症的手术方法。

英文摘要:

  【Abstract】 Objectives: To retrospectively investigate the clinic outcome of the percutaneous coaxial endoscopic combined transforaminal and interlaminar approaches for mixed lumbar spine canal stenosis. Methods: Thirteen cases with mixed lumbar spinal stenosis underwent percutaneous endoscopic decompression by combined transforaminal and interlaminar approaches from June 2012 to January 2015. The neurogenic intermittent claudication was presented in all patients. The visual analogue scale(VAS) scores and Oswestry disability index(ODI) scores were recorded preoperatively and at final follow-up to evaluate the back and sciatica pain and the function of lumbar. The Nakai criteria were involved to assess the recovery rate. Results: All procedures were performed in local anesthesia successfully. There were two complications noted, one sheath of nerve root tear and one bleeding intraoperatively. Fortunately, no severe consequence was noted after the procedure. The mean duration of hospital stay was 4.7±1.2 days and the average follow-up time was 19.6±9.0 months. The VAS scores of back pain and the sciatica decreased from 4.6±0.8 and 4.7±0.9 preoperatively to 1.8±0.9 and 1.0±0.7 at final follow-up. The ODI score decreased from (32.7±6.9)% preoperatively to (10.5±3.0)% at final follow-up. All data mentioned above showed significant differences between pre- and postoperation(P<0.01). The excellent and good rate was 76.9% according to Nakai criteria(excllent: 6; good: 4, fair: 2; bad: 1). Conclusions: It is effective and safe for mixed lumbar stenosis by using percutaneous endoscopic combined transforaminal and interlaminar approaches, which have the advantages of less invasive, rapid recovery and short duration of hospital stay. This technique can be used as an alternative for the mixed lumbar stenosis, especially for the elderly patient with high risk for general anesthesia.