经皮椎间孔路径下内镜治疗中央型腰椎管狭窄症的疗效分析

目的探究经皮椎间孔路径下内镜治疗中央型腰椎管狭窄症(LSS)的临床疗效。方法选取2015年1月至2017年1月我院脊柱外科收治的35例中央型LSS患者作为研究对象。所有患者均采用经皮椎间孔路径内镜下椎管扩大成形、椎间盘摘除、神经根及椎管减压治疗,术后随访2年以上。记录手术完成情况,术后1个月、6个月、末次随访评估腰及下肢疼痛视觉模拟(VAS)评分、日本骨科学会(JOA)评分以及Oswestry功能障碍指数(ODI),末次随访参照改良MacNab标准评估综合疗效并记录随访期间并发症及复发情况。结果35例患者均顺利完成手术,手术时间(96.44±15.12)min,术中透视(9.72±3.34)次,出血量(18.11±4.31)mL、住院时间(4.12±1.12)d;术后1个月、6个月、末次随访,腰、下肢VAS评分、ODI逐渐降低,JOA评分逐渐升高,差异有统计学意义(P<0.05);末次随访MacNab标准手术优良率为88.57%;术后发生一过性腰腿痛2例,慢性腰痛1例,复发2例,无神经损伤加重、感染等严重并发症。结论经皮椎间孔路径下内镜治疗中央型LSS创伤较小,术后恢复快,能有效改善疼痛症状及功能障碍。

Curative effect of percutaneous endoscopic transforaminal approach in treatment of central lumbar spinal stenosis

Objective To study the curative effect of percutaneous endoscopic transforaminal approach in treatment of central lumbar spinal stenosis(LSS).Methods Totally 35 patients with central LSS treated in our spinal surgery department from January 2015 to January 2017 were selected.All patients underwent spinal canal enlargement,discectomy,and nerve root and spinal canal decompression under percutaneous endoscope.All patients were followed up for more than 2 years.The completion of the operation were recorded.The waist and lower extremity pain visual analogue score(VAS),Japanese orthopaedic association(JOA)score,and Oswestry dysfunction index(ODI)were evaluated at 1 month,6 months after surgery,and at the last follow-up.At the last follow-up,the modified MacNab criteria was used to evaluate the overall efficacy.The complications and recurrence during the follow-up period were recorded.Results All the 35 patients successfully completed the operation,the surgery time was(96.44±15.12)minutes,intraoperative fluoroscopy was(9.72±3.34)times,amount of bleeding was(18.11±4.31)mL,hospitalization stay was(4.12±1.12)days.At 1 month,6 months after surgery,and the last follow-up,the VAS score and ODI of the waist and lower extremities gradually decreased,and the JOA score gradually increased,the differences were statistically significant(P<0.05).The excellent and good rate of surgery by MacNab standard at the last follow-up was 88.57%.After operation,2 cases had transient back and leg pain,1 case had chronic low back pain,2 cases had recurrence,no serious neurological damage,infection nor other serious complications occurred.Conclusion Percutaneous endoscopic transforaminal approach in treatment of central LSS can effectively improve the pain symptoms and dysfunction,with less traumatic and quicker postoperative recovery.