椎间孔入路完全脊柱内镜治疗 腰椎管狭窄症的早期疗效

Short-term outcome of complete spinal endoscopy via intervertebral foramen approach for lumbar spinal stenosis

摘要:

目的 探讨椎间孔入路完全脊柱内镜治疗腰椎管狭窄症的早期疗效。方法 选取2013 年6 月- 2015 年8 月广西中医药大学第一附属医院和广西中医药大学附属瑞康医院诊断为腰椎管狭窄症患者32 例，采 用经皮椎间孔入路完全脊柱内镜进行椎管扩大成形+ 腰椎间盘摘除术+ 神经根管减压术，采用腰痛视觉模拟评 分法（VAS）、腿痛VAS 评分、Oswestry 功能障碍指数（ODI）及改良Macnab 疗效标准评价早期疗效。结果 31 例顺利完成手术，1 例因疼痛不能长时间俯卧转为开放手术。手术时间45 ～ 130 min，术中透视次数4 ～ 16 次，术中出血量5 ～ 25 ml。31 例获得随访，随访时间（14±5）个月。术前腰痛VAS 评分为（5.8±1.1）分、 术后即刻腰痛VAS 评分为（2.6±1.0）分，术后3 个月腰痛VAS 为（2.5±0.9）分，术后1 年随访时（2.2±0.8）分， 与术前时比较差异有统计学意义（P <0.05）。术前腿痛VAS 评分为（5.9±1.4）分，术后即刻腿痛VAS 评分 为（2.5±1.0）分，术后3 个月腿痛VAS 分为（2.3±0.7）分，术后1 年随访时VAS 评分为（2.3±0.8）分，与 术前比较差异有统计学意义（P <0.05）。ODI 评分术前为（72.6±14.8）%，术后即刻为（28.2±11.6）%，术 后3 个月为（26.6±9.4）%，术后1 年随访时为（21.8±6.2）%，与术前比较差异有统计学意义（P <0.05），采 用改良Macnab 疗效评定标准：优11 例，良15 例，可4 例，差1 例，优良率为83.9%。1 例（3.2%）患者术后3 个月行开放手术。结论 椎间孔入路完全脊柱内镜治疗腰椎腰椎管狭窄症创伤小，出血量少，康复快等优势，近 期效果满意，远期效果需进一步随访。

Abstract:

Objective To explore the short-term outcome of percutaneous transforaminal approach microendoscopy for central lumbar spinal canal stenosis. Methods From June 2013 to August 2015, 32 cases were diagnosed with central lumbar spinal canal stenosis in the First Affiliated Hospoital and Ruikang Hospoital of Guangxi University of Chinese Medicine. These patients underwent percutaneous transforaminal approach spinal endoscopy for spine canal enlargement and discectomy as well as decompression of nerve root canal by the same surgeon team. The short-term outcome of all patients were evaluated using the VAS scores of lower back pain and leg pain, Oswestry disability index (ODI) and a modified Macnab criterion. Results The operation was successfully completed on 31 patients, 1 case who could not tolerate pain changed to have open surgery. The duration of the operation was 45-130 min. The intraoperative fluoroscopy was performed 4-16 times. The intraoperative blood loss was 5-25 ml. Of the 32 patients, 31 patients were followed up for a mean duration of (14 ± 5) m (ranging 10- 25 m). The lower back pain VAS scores before operation, immediately after operation, 3 months after operation and 1 year after operation were (5.8 ± 1.1), (2.6 ± 1.0), (2.5 ± 0.9) and (2.2 ± 0.8) separately. The preoperative lower back pain VAS score was statistically different from the postoperative VAS scores (P < 0.05). The leg pain VAS scores before operation, immediately after operation, 3 months after operation and 1 year after operation were (5.9 ± 1.4), (2.5 ± 1.0), (2.3 ± 0.7) and (2.3 ± 0.8) separately. There were significant differences between the preoperative leg pain VAS score and different postoperative leg pain VAS scores (P < 0.05). The ODI was (72.6 ± 14.8)%, (28.2 ± 11.6)%, (26.6 ± 9.4)% and (21.8 ± 6.2)% separately before operation, immediately after operation, 3 months after operation and 1 year after operation. There were statistical differences between the preoperative ODI and different postoperative ODIs (P < 0.05). Using the modified Macnab criterion, the short-term outcome was excellent in 11 patients, good in 15 patients, fair in 4 patients and poor in 1 patient; the excellent and good rate was 83.9%. And 1 patient (3.2%) underwent open surgery 3 months after the operation. Conclusions Percutaneous transforaminal approach microendoscopy is effective and has the advantages of small wound, little blood loss and quick recovery in treatment of central lumbar spinal canal stenosis, the short-term outcome is satisfactory, while the long-term therapeutic effect needs to be further observed.