椎间孔镜BEIS技术治疗老年腰椎侧隐窝狭窄症

目的 :探讨经皮椎间孔镜BEIS(broad easy immediate surgery)技术治疗老年腰椎侧隐窝狭窄症的安全性及有效性。方法:2014年2月至2016年5月,采用经皮椎间孔镜BEIS技术治疗21例老年腰椎侧隐窝狭窄症患者,其中男13例,女8例,年龄70~85岁,平均74.3岁。记录术前、术后1、12个月腿痛视觉模拟评分(visual analogue scale,VAS)及Oswestry功能障碍指数(Oswestry Disability Index,ODI),统计分析术前及术后各时间点的差异。用改良MacNab标准评价疗效。结果 :21例患者均顺利完成手术,手术时间90~130 min,平均110 min。所有病例获得随访,时间12~38个月,平均18个月。术前、术后1、12个月的VAS评分分别为8.47±1.23、1.78±0.72、0.68±0.32,术前、术后1、12个月的ODI评分分别为32.48±10.03、19.53±3.55、5.15±1.02,术后2个时间点随访的VAS评分及ODI评分,均较术前明显改善(P0.05)。术后12个月采用改良Mac Nab标准评定疗效,优14例,良5例,可2例。术后出现下肢感觉异常1例,给予保守治疗,术后3周恢复。1例肺气肿患者术后出现肺部感染,经抗感染治疗后控制。无椎体或椎间隙感染、血管及神经根损伤、硬脊膜撕裂脑脊液漏等并发症发生。结论:经皮椎间孔镜BEIS技术治疗老年腰椎侧隐窝狭窄症是一种安全、有效、微创的手术方法,但技术难度较大,特别是对于严重的椎间孔狭窄,经椎间孔入路操作困难,应严格把握手术适应证。术后可能并发神经激惹及术后感觉异常。

Application of broad easy immediate surgery in percutaneous transforaminal endoscopic technology for lumbar lateral recess stenosis in the elderly

Objective: To explore the safety and effectiveness of percutaneous transforaminal endoscopic BEIS technology for lumbar lateral recess stenosis in the elderly.Methods: From February 2014 to May 2016,21 patients with lumbar lateral recess stenosis in elderly were treated with percutaneous endoscopic BEIS. There were 13 males and 8 females,aged from 70 to 85 years old with an average of 74.3 years. Preoperative,1 and 12 months postoperative visual analogue scale(VAS) scores and Oswestry Disability Index(ODI) were statistically analyzed. MacNab was used to assess the clinical effects.Results: All the operations were successful. The time ranged from 90 to 130 min with an average of 110 min. All the patients were followed up for 12 to 38 months with an average of 18 months. Preoperative,1 and 12 months postoperative VAS scores were 8.47±1.23,1.78±0.72,0.68±0.32,and ODI scores were 32.48±10.03,19.53±3.55,and 5.15±1.02,respectively. Postoperative scores of VAS and ODI were obviously improved(P<0.05). According to modified MacNab standard to evaluate the clinical effects,14 cases obtained excellent results,5 good,2 fair. Lower limb paresthesia occurred in 1 case,and the condition was restored at 3 months postoperatively with conservative treatment. One patient was complicated with emphysema before operation secondary to pulmonary infection,and was effectively controlled with regulate antibiotic therapy. No infection of vertebral body or intervertebral space,no injuries of blood vessels or nerve root,no tear of dura,or the leakage of cerebrospinal fluid were found.Conclusion: Percutaneous transforaminal endoscopic BEIS is a safe and effective method for lumbar lateral recess stenosis in the elderly.