双管大通道椎板间内镜术式治疗腰椎管狭窄症

目的 提出双管大通道椎板间内镜术式治疗腰椎管狭窄症(lumbar spinal stenosis,LSS)，并探讨其临床疗效。方法 借助椎间盘镜手术工作通道，应用操作水介质椎板间脊柱内镜进行椎管减压，即为双管大通道椎板间内镜术式。回顾性收集分析海军总医院康复医学科及脊柱微创中心应用双管大通道椎板间内镜术式治疗17例LSS患者的临床资料。所有患者分别于术后即刻、6个月及末次随访进行疗效评估，记录视觉模拟评分、腰椎疾患日本骨科协会评估治疗评分、Oswestry功能残障量表及SF 36生活质量量表评定分值，比较不同时间点的治疗结果，并计算临床治疗优良率。结果 平均随访(12.5±7.3)月，术后6个月治疗优良率为70.59%，末次随访治疗优良率达82.35%。随访显示临床症状大都有较满意改善，腰腿疼痛缓解、生活质量提高、社会活动适应性增加，无严重并发症发生。结论 应用双管大通道椎板间内镜术式治疗LSS疗效肯定、安全可靠，具有临床实用价值及意义。大宗病例、多中心研究有待进一步深入开展。

TUBE IN TUBE interlaminar endoscopic surgery for the treatment of lumbar spinal stenosis

Objective To put forward TUBE IN TUBE interlaminar endoscopic surgery method for the treatment of lumbar spinal stenosis (LSS), and to explore the related clinical outcome. Methods Taking advantage of microendoscopic discectomy channel tube, we used the water-medium spinal endoscopy to perform trans-interlaminar canal decompression which referred to TUBE IN TUBE technique. Seventeen patients with LSS were treated and the retrospective study was conducted. All patients were followed-up regularly, and the clinical efficiency was evaluated at six months postoperatively and the final time point. Scores of Visual Analogue Scale, Japanese Orthopaedic Association Scores, Oswestry Disability Index and SF-36 were calculated and recorded. These scores at different time points were analyzed and compared, and also, the clinical treatment efficiency was calculated. Results The mean follow-up period was 12.5±7.3 months. The excellent rate was 70.59% at six months postoperatively, while it was 82.35% at the final follow-up. It showed that the clinical outcome was satisfied, with the improvement of low back and leg pain, quality of the daily life and adaptability of the social activity. No serious complication occurred. Conclusion TUBE IN TUBE technique, which has a positive clinical outcome in LSS patients, is safe, reliable and valuable. Anyway, large number of cases and multi-center research need to be further developed.