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

发布时间：2018-04-17 05:01

本文选题：退变性腰椎管狭窄症 + 微创外科手术　；参考：《中国脊柱脊髓杂志》2017年03期

【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Mac Nab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(P0.05)。术后24个月时改良Mac Nab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。
[Abstract]:Objective: to evaluate the clinical effect of percutaneous interlaminar approach decompression for degenerative lumbar spinal stenosis.Methods: from January 2014 to December 2014, 126 patients with degenerative lumbar spinal stenosis (82 males and 44 females) were treated by percutaneous interlaminar decompression, and 73 patients with L5-S1 stenosis aged 46 ~ 83 years (65.8 卤12.4 years old).The patients were evaluated with visual analogue scale scale and Oswestry disability index during preoperative and postoperative follow-up, and the clinical efficacy was evaluated by modified Mac Nab.Results the operation was performed successfully in all the 126 cases. The operative time was 48~75min(61.4 卤11.4min, the operative time was 2. 4 卤0. 3 times, the incision length was about 7 mm, and the hospitalization time was 2. 2 卤0. 2 d.There were no complications such as dural sac tear and nerve root injury during operation.The VAS scores of low back pain were 4.80 卤1.46 and 3.21 卤0.75 卤1.88 卤1.15 卤1.81 卤1.05 卤0.63 卤0.62 before and 1 day, 1 month, 3 months, 6 months, 12 months and 24 months after operation, respectively.The VAS scores of leg pain were 7.88 卤0.81 and 2.88 卤1.45 卤2.13 卤1.02, 0.88 卤0.62, 0.81 卤0.54 and 0.82 卤0.23, respectively, and the ODI were 67.63 卤9.91 and 38.4 卤10.46 26.75 卤6.89.81 卤5.59.19 卤6.049.22 卤4.56at 1 month, 3 months, 6 months, 12 months and 24 months after operation, respectively.The VAS and ODI scores of postoperative low back pain were significantly different from those before operation (P 0.05).At 24 months after operation, improved Mac Nab was used to evaluate the curative effect in 89 cases, good in 25 cases, fair in 12 cases. The excellent and good rate was 90.5%.Conclusion: decompression under percutaneous interlaminar approach for degenerative lumbar spinal stenosis has less trauma, less fluoroscopy, accurate decompression, quick postoperative recovery and good short-term curative effect.
【作者单位】：四川大学华西医院骨科;
【基金】：成都市科技惠民技术研发项目(编号:2015-HM01-00637-SF) 四川大学华西医院学科卓越发展135工程项目(编号:ZY2016204)
【分类号】：R687.3

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