经皮内镜下减压治疗老年腰椎管狭窄症合并退变性脊柱侧凸的疗效分析

Clinical efficacy of percutaneous endoscopic decompression in treating lumbar spinal stenosis combined with degenerative scoliosis in geriatric patients

中文关键词:  腰椎管狭窄症  经皮内镜下减压  退变性脊柱侧凸  疗效

英文关键词:Percutaneous endoscopic decompression  Lumbar spinal stenosis  Degenerative scoliosis  Clinical efficacy

中文摘要:

  【摘要】 目的：评价经皮内镜下减压治疗老年腰椎管狭窄症（lumbar spinal stenosis，LSS）合并退变性脊柱侧凸的临床疗效。方法：回顾性分析2020年1月~2021年6月采用经皮内镜下减压治疗的LSS合并退变性脊柱侧凸患者，纳入研究18例，其中男11例，女7例，年龄65~90岁，平均78.9±7.1岁。根据患者临床症状、合并症及影像学特点行经皮内镜单侧或双侧减压。记录手术时间、术中出血量及术中透视次数。术前及末次随访时采用视觉模拟评分法（visual analogue scale，VAS）评估患者术前、术后即刻、术后6个月及末次随访时腰腿痛程度。采用Oswestry功能障碍指数（Oswestry disability index，ODI）和日本骨科学会（Japanese Orthopaedic Association，JOA）评分评估患者腰椎功能状态，采用Macnab标准评估末次随访时患者的手术疗效。分别于术前和术后测量脊柱矢状面偏移（sagittal vertical axis，SVA）、C7椎体中心至骶骨中垂线距离（C7-CSVL）、Cobb角、腰椎前凸角（lumbar lordosis，LL）、骨盆入射角（pelvic incidence，PI）、骨盆倾斜角（pelvic tilt，PT）、骶骨倾斜角（sacral slope，SS）、PI-LL及椎管横截面积，分析术后影像学的改善情况。结果：患者均顺利完成手术，其中双侧减压14例，单侧减压4例，围手术期无严重并发症发生，所有患者完成12个月以上随访。手术时间69.72±12.66min，术中出血量39.72±10.21mL，术前、术中透视次数5.11±1.49次。术后即刻、术后6个月及末次随访时腰腿痛VAS评分较术前均明显降低（P＜0.05）；末次随访时ODI、JOA评分较术前明显改善（P＜0.05）；术后SVA、C7-CSVL、Cobb角、PI-LL及椎管横截面积较术前有所改善（P＜0.05）；末次随访时疗效为优7例（38.90%），良9例（50.00%），可2例（11.11%），整体优良率为88.89%。结论：经皮内镜下减压治疗老年LSS合并退变性脊柱侧凸可缓解患者腰腿痛症状、改善腰椎功能，一定程度改善脊柱-骨盆参数并扩大椎管内横截面积，具有创伤小、出血少、手术时间短的临床特点。

英文摘要:

  【Abstract】 Objectives: To evaluate the clinical efficacy of percutaneous endoscopic decompression in the treatment of lumbar spinal stenosis(LSS) with degenerative scoliosis in geriatric patients. Methods: A retrospective analysis was conducted on the LSS patients combined with degenerative scoliosis underwent percutaneous endoscopic decompression between January 2020 and June 2021. 18 patients(11 males and 7 females) aged 65-90(78.9±7.1) years old were included in the study. Percutaneous endoscopic unilateral or bilateral decompression was performed according to the clinical symptoms, comorbidities and imaging characteristics of the patients. The operative time, intraoperative blood loss and fluoroscopy times were recorded. Visual analogue scale(VAS) was used to evaluate back and leg pain before and immediately after operation, and at 6 months after surgery and final follow-up. Oswestry disability index(ODI) and Japanese Orthopaedic Association(JOA) score were applied to evaluate lumbar function before and after operation, and the Macnab criteria were adopted to assess the efficacy at final follow-up. The sagittal vertical axis(SVA), C7-CSVL, Cobb angle, lumbar lordosis(LL), pelvic incidence(PI), pelvic tilt(PT), sacral slope(SS), PI-LL, and cross-sectional area of spinal canal before and after surgery were measured and analyzed. Results: All the patients underwent the surgery successfully, and 14 cases were treated with bilateral decompression and 4 cases with unilateral decompression. There were no serious complications during the perioperative period. The patients completed more than 12 months of follow-up. The operative time was 69.72±12.66min, intraoperative blood loss was 39.72±10.21mL, and the number of preoperative and intraoperative fluoroscopy was 5.11±1.49 times. The VAS scores of low back and leg pain immediately after operation, at 6 months after operation and final follow-up were significantly lower than those before operation(P<0.05). The ODI and JOA score at final follow-up were significantly improved compared with those before operation(P<0.05). The postoperative SVA, C7-CSVL, Cobb angle, PI-LL, and cross-sectional areas of spinal canal were improved compared with the preoperative values, respectively(P<0.05). There were 7 excellent cases(38.90%), 9 good cases(50.00%) and 2 acceptable cases(11.11%) at the final follow-up, and the total excellent and good rate was 88.89%. Conclusions: Percutaneous endoscopic decompression has the clinical efficacies of relieving back and leg pain, improving lumbar function and spino-pelvic alignment, and enlarging intraspinal cross-sectional area in treating old LSS patients with degenerative scoliosis, and it is small in wound, little in bleeding, and short in operative time.