经皮椎板间入路内窥镜下减压治疗退变性腰椎管狭窄症的疗效分析

Percutaneus endoscopic interlaminar decompression in degenerative lumbar spinal stenosis

中文关键词:  退变性腰椎管狭窄症  微创外科手术  经皮椎板间入路  椎板开窗  内窥镜

英文关键词:Degenerative lumbar spinal stenosis  Microsurgery  Percutaneus endoscopic interlaminar  Laminotomy

中文摘要:

  【摘要】 目的：评估经皮椎板间入路内窥镜下减压治疗退变性腰椎管狭窄症的临床疗效。方法：2014年1月~2014年12月采用经皮椎板间入路内窥镜下减压治疗退变性腰椎管狭窄症126例，男82例，女44例；年龄46~83岁（65.8±12.4岁）。L4-5节段狭窄73例，L5-S1节段狭窄53例。术前和术后随访时采用疼痛视觉模拟评分（visual analogue scale，VAS）、Oswestry功能障碍指数（Oswestry disability index，ODI）对患者进行评估，改良MacNab评价临床疗效。结果：126例患者手术均顺利完成，手术时间48~75min（61.4±11.4min），术中透视2~4次（2.4±0.3次），手术切口长约7mm，住院时间3~4d（3.2±0.2d）。术中均未发生硬膜囊撕裂、神经根损伤等并发症。随访24~30个月（26.5±2.1个月），术前和术后1d、1个月、3个月、6个月、12个月、24个月时的腰痛VAS评分分别为4.80±1.46分和3.21±0.75分、1.88±1.15分、1.81±1.05分、0.63±0.62分、0.25±0.15分、0.28±0.12分；腿痛VAS评分分别为7.88±0.81分和2.88±1.45分、2.13±1.02分、1.38±0.62分、0.88±0.62分、0.81±0.54分、0.82±0.23分；术前和术后1个月、3个月、6个月、12个月、24个月时的ODI分别为67.63±9.91和38.4±10.46、26.75±6.88、13.81±5.95、9.19±6.04、9.22±4.56。术后腰腿痛VAS评分及ODI评分与术前比较均有统计学差异（P<0.05）。术后24个月时改良MacNab评价疗效优89例，良25例，可12例，优良率为90.5%。结论：经皮椎板间入路内窥镜下减压治疗退变性腰椎管狭窄症创伤小，术中透视少，减压精准彻底，术后恢复快，近期疗效好。

英文摘要:

  【Abstract】 Objectives: To assess the clinical outcomes of percutaneus endoscopic interlaminar decompression in degenerative lumbar spinal stenosis(DLSS). Methods: From January 2014 to December 2014, 126 patients with DLSS accepted percutaneus endoscopic interlaminar decompression, including 82 males and 44 females aged from 46-83 years old(average, 65.8±12.4 years). There were 73 patients with stenosis in L4-5 and 53 patients with stenosis in L5-S1. Visual analogue score(VAS), Oswestry disability index(ODI) and modified MacNab were applied to evaluate clinical outcomes before surgery and at the follow-ups. Results: All of the 126 operations had been completed successfully with operation time of 48-75min(61.4±11.4min), 2-4 times(2.4±0.3 times) intraoperative radiation, nearly 7mm incision, 3-4d(3.2±0.2d) hospitalization time, and an average follow-up of 26.5±2.1 months(range, 24-30 months). No complication, such as dural laceration or nerve injury, occurred in operations. Intermittent claudication, lumbocrural pain, decreased sensation, and muscle strength had been improved in different degrees after surgery. All the patients were followed up for 24-30 months(26.5±2.1 months). Before surgery, 1 day, 1 month, 3 months, 6 months, 12 months, and 24 months after surgery, the waist pain VAS score was 4.80±1.46, 3.21±0.75, 1.88±1.15, 1.81±1.05, 0.63±0.62, 0.25±015, 0.28±0.12 respectively, and leg pain VAS score was 7.88±0.81, 2.88±1.45, 2.13±1.02, 1.38±0.62, 0.88±0.62, 0.81±0.54, 0.82±0.23 respectively. ODI score before surgery, 1 month, 3 months, 6 months, 12 months, and 24 months after surgery was 67.63±9.91, 38.4±10.46, 26.75±6.88, 13.81±5.95, 9.19±6.04, 9.22±4.56 respectively. Differences in lumbocrural pain scores and ODI scores between pre-operation and post-operation in multi-period were statistically significant(P<0.05). In the modified MacNab 24 months after surgery, the fineness rate was 90.5%, including 89 cases of excellence, 25 cases of good, and 12 cases of fair. Conclusions: Percutaneus endoscopic interlaminar decompression in DLSS has advantages in limited trauma, short intraoperative radiation exposure time, precise and thorough decompression, and fast recovery after surgery. The short-term outcomes are satisfactory.