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腰椎管狭窄症通常是指各种原因引起椎管、侧隐窝及椎间孔狭窄,压迫硬膜囊及神经根,从而导致相应神经功能障碍的一类疾病[1]。高位腰椎管狭窄的诊断目前没有国际统一标准,大多学者通常将T12~L1、L1~2、L2~3节段狭窄定义为高位腰椎管狭窄[2]。高位腰椎管狭窄症的发病率低,临床表现常混有股神经、坐骨神经症状及不典型腰痛,症状不典型,较容易漏诊和误诊[3]。高位腰椎管内容物多,椎管容积相对狭小,手术难度大,易误伤神经根及硬膜囊,一度被认为属于椎间孔镜手术的禁区。随着对椎间孔局部精细解剖的深入理解及内镜手术技术的不断提高,微创内镜治疗高位腰椎管狭窄症得以临床应用,逐步突破禁区,惠及病人[4]。我们应用经皮内镜椎间孔扩大成形术治疗高位腰椎管狭窄症病人8例,取得较满意效果。现作报道。
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8例病人均在局麻下顺利完成手术,术中出血量少,未予评估,无神经根及硬膜囊损伤及术后出血等并发症,手术时间90~130 min,住院时间5~9 d,切口均一期愈合。7例病人术后根性症状即消失,1例术后出现一过性腰臀部疼痛加重,经保守治疗后缓解。典型病人手术示例见图 1~3。术后随访半年,无复发病例,病人术后各时点VAS评分和ODI指数均低于术前(P<0.05~P<0.01),JOA评分均高于术前(P<0.05)(见表 1)。末次随访时按照MacNad功能评分评价8例病人疗效,优6例,良1例,可1例,优良率达87.50%。
时间 VAS评分 JOA评分 ODI指数 术前 6.86±2.80 12.13±6.89 2.88±1.25 出院时 2.25±1.16** 22.00±6.89* 1.38±0.74* 术后3个月 2.50±1.60** 20.88±6.81* 1.63±0.74* 术后6个月 3.25±1.04** 23.75±6.14* 1.75±0.71* F 11.42 4.79 4.47 P <0.01 <0.01 <0.05 MS组内 3.207 44.755 0.791 q检验:与术前比较*P<0.05,**P<0.01 表 1 病人手术前后不同时点VAS评分、JOA评分和ODI指数比较(n=8;x±s;分)
经皮内镜椎间孔扩大成形术治疗高位腰椎管狭窄症的疗效
Effect of the expanded percutaneous endoscopic foraminal plasty in the treatment of high lumbar spinal stenosis
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摘要:
目的探讨经皮内镜椎间孔扩大成形术治疗高位腰椎管狭窄症的临床疗效。 方法高位腰椎管狭窄症病人8例,均明确诊断为单节段高位腰椎管狭窄症,均采用经皮内镜椎间孔扩大成形术进行治疗。于术前和出院时及术后3、6个月对病人症状及腰部功能进行评价,术后6个月末次随访时采用MacNad功能评分评价病人治疗效果。 结果8例病人均在局部麻醉下顺利完成手术。病人术后各时间点的疼痛视觉模拟评分和腰椎Oswestry功能障碍指数均低于术前(P<0.05~P<0.01),日本骨科协会评分均高于术前(P<0.05)。术后随访6个月,无复发病例,末次随访时按照MacNad功能评分评价病人疗效,优6例,良1例,可1例,优良率达87.50%。 结论经皮椎间孔镜椎间孔区扩大成形术治疗高位腰椎管狭窄症安全、有效。 Abstract:ObjectiveTo evaluate the effects of the expanded percutaneous endoscopic foraminal plasty in the treatment of high lumbar spinal stenosis. MethodsEight patients with high lumbar spinal stenosis were treated with expanded percutaneous endoscopic foraminal plasty.The symptoms and waist function of the patients were evaluated before operation and after 3 and 6 months of operation.The therapeutic effects of patients was evaluated using MacNad function score at the end of 6 months after operation. ResultsEight patients were successfully operated under local anesthesia.At each time point after surgery, the visual analog score of pain and lumbar Oswestry dysfunction index(ODI) in all cases were lower than those before surgery(P<0.05 to P<0.01), and the Japanese orthopaedic association score was higher than that before surgery(P<0.05).No recurrence case was found during 6 months of following up.At the last following-up, the results of MacNad evaluation showed that the excellent in 6 cases, good 1 case and fair in 1 case were identified, and the excellent and good rate of which was 87.50%. ConclusionsThe the expanded percutaneous endoscopic foraminal plasty in the treatment of high lumbar spinal stenosis is safe and effective. -
表 1 病人手术前后不同时点VAS评分、JOA评分和ODI指数比较(n=8;x±s;分)
时间 VAS评分 JOA评分 ODI指数 术前 6.86±2.80 12.13±6.89 2.88±1.25 出院时 2.25±1.16** 22.00±6.89* 1.38±0.74* 术后3个月 2.50±1.60** 20.88±6.81* 1.63±0.74* 术后6个月 3.25±1.04** 23.75±6.14* 1.75±0.71* F 11.42 4.79 4.47 P <0.01 <0.01 <0.05 MS组内 3.207 44.755 0.791 q检验:与术前比较*P<0.05,**P<0.01 -
[1] ISSACK PS,CUNNINGHAM ME,PUMBERGER M,et al.Degenerative lumbar spinal stenosis:Evaluation and management[J].J Am Acad Orthop Surg,2012,20(8):527. doi: 10.5435/JAAOS-20-08-527 [2] REUL J.Treatment of lumbar disc herniations by interventional fluoroscopy-guided endoscopy[J].Interv Neuroradiol,2014,20(5):538. doi: 10.15274/INR-2014-10081 [3] 王德明.后路扩大减压椎体间融合治疗高位腰椎间盘突出症[J].山东医学高等专科学校学报,2018,40(3):234. doi: 10.3969/j.issn.1674-0947.2018.03.031 [4] 张西峰,张琳.脊柱内镜技术的历史、现状与发展[J].中国疼痛医学杂志,2015,21(2):81. doi: 10.3969/j.issn.1006-9852.2015.02.001 [5] 谢江,吐尔洪江·阿布都热西提,孟禅玉,等.上位腰椎不稳合并下段腰椎管狭窄后路手术治疗疗效分析[J].新疆医学,2014,44(11):26. [6] 易泽洪,肖波,杨国奇,等.后路减压经椎间孔椎间融合术治疗钙化型高位腰椎间盘突出症的临床研究[J].四川医学,2014,35(11):1427. [7] 吴俊龙,张超,周跃.微创脊柱内镜技术的发展现状与展望[J].骨科,2016,7(1):65. [8] 罗啸,黄异飞.腰椎管狭窄症的诊断与治疗现况[J].新疆医学,2015,45(10):1527. [9] 丁宇,乔晋琳,崔洪鹏,等.腰椎椎间孔镜微创手术中的区域定位原则及临床疗效观察[J].颈腰痛杂志,2015,5(36):347. [10] YEOM KS,CHOI YS.Full endoscopic contralateral transforaminal discectomy for distally migrated lumbar disc herniation[J].J Orthop Sci,2011,16(3):263.