经皮显微内窥镜下责任节段减压治疗多节段腰椎椎管狭窄症

目的探讨经皮显微内窥镜下责任节段减压治疗多节段腰椎椎管狭窄症的临床疗效。方法回顾性分析2014年9月—2016年10月收治的40例多节段腰椎椎管狭窄症患者的临床资料,所有患者均接受经皮显微内窥镜下责任节段减压治疗,记录手术时间、术中出血量、住院时间,术前及术后疼痛视觉模拟量表(VAS)评分和日本骨科学会(JOA)评分,术后并发症发生情况。采用VAS评分评估患者腰腿疼痛程度,采用JOA评分评估临床疗效。结果所有手术顺利完成,随访12～36(21±3)个月。手术时间50～150(70±15)min,术中出血量50～400(60±5)mL,住院时间3～7(4±1)d。末次随访时,腰痛VAS评分由术前(5.7±1.4)分改善至(1.8±1.7)分,腿痛VAS评分由术前(7.2±2.3)分改善至(1.7±0.9)分;JOA评分由术前(11.0±2.8)分改善至(23.0±2.2)分;差异均有统计学意义(P 0.05)。临床疗效优23例(57.5%),良12例(30.0%),可5例(12.5%),优良率为87.5%。结论采用经皮显微内窥镜下责任节段减压治疗多节段腰椎椎管狭窄症可获得椎管的完全减压,缓解症状,疗效确切。

Responsible segment decompression for multi-segmental lumbar spinal stenosis under percutaneous microendoscope

Objective To investigate the clinical effect of responsible segment decompression under percutaneous microendoscope for multi-segmental lumbar spinal stenosis. Methods From September 2014 to October 2016, the clinical data of 40 patients with multi-segmental lumbar stenosis were reviewed retrospectively. All the patients received percutaneous microendoscopic decompression of the responsibility segment. The operation time, intraoperative blood loss, hospital stay, preoperative and postoperative visual analogue scale(VAS) and Japanese Orthopaedic Association(JOA) scores, and complications were recorded. VAS score was used to evaluate the degree of lumbar and leg pain, and JOA score was used to evaluate the clinical efficacy. Results All the patients completed the operation successfully and were followed up for 12-36 (21±3) months. The operation time was 50-150(70±15) min, the intraoperative blood loss was 50-400(60±5) mL, and the hospital stay was 3-7(4±1) d. At the final follow-up, the VAS score of low back pain was improved from preoperative (5.7±1.4) to (1.8±1.7), the VAS score of leg pain was improved from preoperative(7.2±2.3) to (1.7±0.9), and the JOA score was improved from preoperative(11.0±2.8) to (23.0±2.2), the differences were statistically significant (P<0.05). The clinical efficacy was excellent in 23 cases(57.5%), good in 12(30.0%) and fair in 5(12.5%). The excellent and good rate was 87.5%. Conclusion Percutaneous microendoscope for multi-segmental lumbar spinal stenosis can achieve complete decompression of the spinal canal, relieve symptoms, and have a definite effect.