[1]付松 吕仁花① 朱凤祥 王龙强 王亚楠 刘海军 邵诗泽*.经皮椎间孔入路内镜下选择性责任节段减压治疗老年腰椎侧隐窝狭窄症[J].中国微创外科杂志,2020,01(9):798-801.
　Fu Song*,Lv Renhua,Zhu Fengxiang*,et al.Percutaneous Endoscopic Transforaminal Approach Selective Responsible Segment Decompression for Lumbar Lateral Recess Stenosis in Elderly Patients[J].Chinese Journal of Minimally Invasive Surgery,2020,01(9):798-801.
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经皮椎间孔入路内镜下选择性责任节段减压治疗老年腰椎侧隐窝狭窄症()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2020年9期
页码:
798-801
栏目:
临床研究
出版日期:
2020-09-25

文章信息/Info

Title:
Percutaneous Endoscopic Transforaminal Approach Selective Responsible Segment Decompression for Lumbar Lateral Recess Stenosis in Elderly Patients
作者:
付松 吕仁花① 朱凤祥 王龙强 王亚楠 刘海军 邵诗泽*
（山东省文登整骨医院脊柱脊髓科，威海264400）
Author(s):
Fu Song*;  Lv Renhua;  Zhu Fengxiang*;  et al.
*Department of Spinal Cord, Shandong Wendeng Orthopeadic Hospital, Weihai 264400, China
关键词:
侧隐窝狭窄; 老年患者; 椎间孔入路; 内镜; 神经根阻滞
Keywords:
Lateral recess stenosis; Elderly patients; Intervertebral foramen approach; Endoscope; Nerve root block
文献标志码:
A
摘要:
目的探讨经皮椎间孔入路内镜下选择性责任节段减压治疗老年腰椎侧隐窝狭窄症的效果。方法2014年5月~2016年7月我科对81例神经根阻滞明确责任节段的老年腰椎侧隐窝狭窄症在局部麻醉下行椎间孔镜下椎间孔入路椎管扩大减压术。椎间孔成形后，切除突出的髓核组织及增厚的黄韧带，将侧方的椎管打开，神经根完全松弛。术后1、6、12个月及末次随访进行Oswestry功能障碍指数（Oswestry Disability Index，ODI），腰、腿疼痛视觉模拟评分（Visual Analogue Scale，VAS），改良MacNab标准评价疗效。结果81例均完成手术，手术时间57~138 min，（68.4±31.9）min。81例随访24~48个月，（29.5±3.8）月。术后1、6、12个月及末次随访时ODI、腰痛VAS评分及腿痛VAS评分较术前显著好转（P<0.05）。末次随访改良MacNab标准评估，优57例，良18例，可6例，优良率92.6%（75/81）。结论经皮椎间孔入路内镜下选择性责任节段减压治疗老年腰椎侧隐窝狭窄症，能很好地缓解症状，严重并发症少。
Abstract:
ObjectiveTo discuss the effect of percutaneous endoscopic transforaminal approach selective responsible segment decompression for lumbar lateral recess stenosis in the elderly. MethodsFrom May 2014 to July 2016, 81 cases of senile lumbar lateral recess stenosis with definite responsible segment for nerve root block were included. All the patients underwent decompression through foramen under local anesthesia. After the intervertebral foraminoplasty, the protruding nucleus pulposus tissue and the thickened ligamentum flavum were removed. The lateral spinal canal was opened and the nerve root was completely relaxed. The Oswestry Disability Index (ODI), the Visual Analogue Scale (VAS) of the pain of the waist and lower limbs and the clinical efficacy of improved MacNab were evaluated at the time of 1, 6, 12 months and final followup.ResultsThe operations were completed in all the 81 patients. The operation time was 57-138 min, with an average of (68.4±31.9) min. The followup time was 24-48 months, with an average of (29.5±3.8) months. After 1, 6, 12 months and the last followup, the ODI, the VAS scores of low back pain and the leg pain were significantly improved, and the differences were statistically significant as compared with those before operation (P<0.05). At the last followup, the modified MacNab criteria assessed excellent outcomes in 57 cases, good in 18 cases, and fair in 6 cases, with an excellent and good rate of 92.6%(75/81).ConclusionSelective responsible segment decompression under percutaneous endoscopy for the treatment of lumbar lateral recess stenosis in the elderly can relieve symptoms well and decrease serious complications.

参考文献/References:

[1]Sigmundsson FG, Jnsson B, Strmqvist B. Impact of pain on function and health related quality of life in lumbar spinal stenosis. A register study of 14,821 patients. Spine (Phila Pa 1976),2013,38(15):E937-E945.
[2]Kambin P, Casey K, O’Brien E, et al. Transforaminal arthroscopic decompression of lateral recess stenosis. J Neurosurg,1996,84(3): 462-467.
[3]Komp M, Hahn P, Oezdemir S, et al. Bilateral spinal decompression of lumbar central stenosis with the fullendoscopic interlaminar versus microsurgical laminotomy technique: a prospective, randomized, controlled study. Pain Physician,2015,18(1):61-70.
[4]程才，辛大森，王路，等.椎间孔镜 TESSYS 技术治疗单责任节段腰椎管狭窄症的近期结果.中国微创外科杂志,2018,18(10):920-923.
[5]顾宇彤，李云飞，朱东晖，等.一种新的经皮椎间孔镜技术治疗腰椎术后椎间盘突出症的疗效分析.中国微创外科杂志,2018,18(5):389-393.
[6]Macnab I. Negative disc exploration an analysis of the causes of nerveroot involvement in sixtyeight patients. J Bone Joint Surg Am,1971,53(5):891-903.
[7]Anandjiwala J，Seo JY，Ha KY，et al． Adjacent segment degeneration after instrumented posterolateral lumbar fusion: a prospective cohort study with a minimum fiveyear followup．Eur Spine J，2011，20(11):1951-1960．
[8]Kobayashi S. Pathophysiology, diagnosis and treatment of intermittent claudication in patients with lumbar canal stenosis. World J Orthop, 2014,5(2):134-145.
[9]钱宇,徐国健, 金聪,等.腰椎管狭窄症致压因素与减压方式关系的研究.中华骨科杂志,2016,36(22):1417-1425.
[10]Chang F, Zhang T, Gao G, et al. Comparison of the minimally invasive and conventional open surgery approach in the treatment of lumbar stenosis: A systematic review and a metaanalysis. Ann Acad Med Singapore,2017,46(4):124-137.
[11]李广松，乔荣慧，刘伟，等.经椎间孔脊柱内窥镜技术治疗腰椎间盘突出症合并神经根管狭窄.中国微创外科杂志,2015,15(6):522-526.
[12]余洋，谭彪，杨世鹏，等.经皮内镜可视化椎间孔成形技术治疗腰椎间盘突出症.中国微创外科杂志,2018,18(9):779-786.
[13]Kim HS, Patel R, Paudel B, et al. Early outcomes of endoscopic contralateral foraminal and lateral recess decompression viaaninterlaminar approach in patients with unilateral radiculopathy from unilateral foraminalstenosis. World Neurosurg,2017,108(12):763-773.
[14]Sairyo K, Matsuura T, Higashino K, et al. Surgery related complications in percutaneous endoscopic lumbar discectomy under local anesthesia. J Med Invest,2014,61(3-4): 264-269.
[15]Jacquot F，Gastambide D．Percutaneous endoscopic transforaminal lumbar interbodyfusion: is it worth it? Int Orthop,2013,27(8):1507-1510.
[16]Beynon R，Hawkins J，Laing R，et al．The diagnostic utility and cost effectiveness of selective nerve root blocks in patients considered forlumbar decompression surgery: a systematic review and economic model. Health Technol Assess,2013,17(19):1-88.

备注/Memo

备注/Memo:
*通讯作者，Email：wdzgssz@163.com ①（山东省威海市文登中心医院神经内科，威海264423）
更新日期/Last Update: 2020-12-09