[1]郭时空 高浩然 高全有 张小平 袁一方 钱澍 宋扬 周程沛 钱济先**.经皮椎板间入路大通道内镜下减压治疗腰椎管狭窄症[J].中国微创外科杂志,2020,01(12):1088-1092.
　Guo Shikong,Gao Haoran,Gao Quanyou,et al.Percutaneous Large Diameter Endoscopic Interlaminar Decompression for Lumbar Spinal Stenosis[J].Chinese Journal of Minimally Invasive Surgery,2020,01(12):1088-1092.
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经皮椎板间入路大通道内镜下减压治疗腰椎管狭窄症()
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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12期
页码:
1088-1092
栏目:
临床研究
出版日期:
2020-12-25

文章信息/Info

Title:
Percutaneous Large Diameter Endoscopic Interlaminar Decompression for Lumbar Spinal Stenosis
作者:
郭时空 高浩然 高全有 张小平 袁一方 钱澍 宋扬 周程沛 钱济先**
（空军军医大学唐都医院骨科，西安710038）
Author(s):
Guo Shikong;  Gao Haoran;  Gao Quanyou;  et al.
Department of Orthopedics, Tangdu Hospital, Air Force Military Medical University, Xi’an 710038, China
关键词:
经皮椎板间入路; 大通道内镜; 腰椎管狭窄症
Keywords:
Percutaneous interlaminar approach; Large diameter endoscopy; Lumbar spinal stenosis
文献标志码:
A
摘要:
目的探讨经皮椎板间入路大通道内镜下减压治疗腰椎管狭窄症（lumbar spinal stenosis，LSS）的临床疗效。方法2017年1月~2019年1月我科采用经皮椎板间入路大通道内镜下减压治疗LSS 36例。透视定位症状侧椎板间隙中心，建立工作通道，大通道内镜下显露骨性解剖标志，扩大椎板窗及骨性侧隐窝，咬除肥厚黄韧带，摘除突出的椎间盘组织，完成硬膜囊及神经根腹、背侧减压。对于中央管狭窄的患者，采用单侧入路双侧减压技术。采用视觉模拟评分（Visual Analogue Scale，VAS）、Oswestry功能障碍指数（Oswestry Disability Index，ODI）和改良MacNab疗效评定标准评价临床疗效。结果36例均顺利完成手术，手术时间（89.3±14.4）min，术中出血量（14.4±3.7）ml，住院时间（7.2±1.2）d。36例随访（19.6±5.3）月。术前、术后第1天、3个月、半年、1年、末次随访时腰痛VAS评分中位数分别为2（1~3）、2（0~3）、1（0~3）、1（0~3）、1（0~2）、1（0~2）分，腿痛VAS评分中位数分别为6（4~8）、2（0~3）、1（0~2）、1（0~2）、1（0~2）、0.5（0~2）分；术前、术后3个月、半年、1年、末次随访时ODI分别为（64.13±16.39）%、（16.43±2.88）%、（13.70±290）%、（9.83±301）%、（7.84±3.25）%。术后腰、腿痛VAS评分和ODI与术前相比均明显下降（P＜0.05）。末次随访改良MacNab疗效评定：优26例，良7例，可3例，优良率91.7%（33/36）。结论经皮椎板间入路大通道内镜下减压治疗LSS近期临床疗效满意，具有创伤小、透视少、镜下操作空间更大等优点。
Abstract:
ObjectiveTo evaluate the clinical efficacy of percutaneous large diameter endoscopic interlaminar decompression for lumbar spinal stenosis.MethodsFrom January 2017 to January 2019, 36 patients with lumbar spinal stenosis underwent percutaneous large diameter endoscopic interlaminar decompression. The working channel was established after fluoroscopy to determine the center of the interlaminar space on the symptomatic side. The bony anatomical landmarks were exposed under the large channel endoscope. After enlarging lateral recess and partial laminectomy, the hypertrophic ligamentum flavum and the herniated disc were removed to complete the ventral and dorsal decompression of the dural sac and nerve root. Bilateral decompression via unilateral approach was conducted for patients with central canal stenosis. The Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and modified MacNab criterion were used to evaluate the clinical efficacy.ResultsAll of the 36 operations had been completed successfully. The operation time was (89.3±14.4) min. The amount of bleeding during operation was (14.4±3.7) ml and the hospitalization time was (7.2±1.2) d. All the patients were followed up for (19.6±5.3) months. Before operation, 1 day, 3 months, 6 months, 12 months, and the last followup after surgery, the median VAS scores of low back pain were 2 (1-3), 2 (0-3), 1 (0-3), 1 (0-3), 1 (0-2), and 1 (0-2) points, respectively, and the median VAS scores of leg pain were 6 (4-8), 2 (0-3), 1 (0-2), 1 (0-2), 1 (0-2), and 0.5 (0-2) points, respectively. The ODI were (64.13±16.39)% before operation, (16.43±288)% at 3 months after surgery, (13.70±2.90)% at 6 months after surgery, (9.83±3.01)% at 12 months after surgery, and (7.84±3.25)% at the last followup. The VAS scores and ODI after surgery significantly decreased as compared with those before operation, and the differences were statistically significant (P<0.05). At the last followup, the modified MacNab criterion was used to evaluate the clinical efficacy. The excellent and good rate was 91.7%(33/36), including 26 cases of excellence, 7 cases of good, and 3 cases of fair.ConclusionPercutaneous large diameter endoscopic interlaminar decompression for lumbar spinal stenosis has a satisfactory shortterm clinical efficacy, with advantages of less trauma, less fluoroscopy, and larger operating space.

参考文献/References:

[1]Kovacs FM, Urrútia G, Alarcón JD. Surgery versus conservative treatment for symptomatic lumbar spinal stenosis: a systematic review of randomized controlled trials. Spine (Phila Pa 1976),2011,36(20):1335-1351.
[2]Ulrich NH, Kleinstück F, Woernle CM, et al. Clinical outcome in lumbar decompression surgery for spinal canal stenosis in the aged population: A prospective Swiss multicenter cohort study. Spine (Phila Pa 1976),2015,40(6):415-422.
[3]Vasudeva VS, Chi JH. Fusion surgery for lumbar spinal stenosis. N Engl J Med,2016,375(6):597-601.
[4]Peng H, Tang G, Zhuang X, et al. Minimally invasive spine surgery decreases postoperative pain and inflammation for patients with lumbar spinal stenosis. Exp Ther Med,2019,18(4):3032-3036.
[5]范国鑫,朱炎杰,管晓菲,等.经皮内窥镜下腰椎椎管减压术的研究进展.脊柱外科杂志,2015,13(6):382-384.
[6]李冬月,杨晋才,海涌.经皮椎间孔镜下减压治疗老年腰椎管狭窄症.中国矫形外科杂志,2019,27(15):1360-1364.
[7]Kapetanakis S, Gkantsinikoudis N, Thomaidis T, et al. The role of percutaneous transforaminal endoscopic surgery in lateral recess stenosis in elderly patients.Asian Spine J,2019,13(4):638-647.
[8]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.
[9]Yeung AT. Minimally invasive disc surgery with the Yeung endoscopic spine system(YESS). Surg Technol Int,1999,8:267-277.
[10]Hoogland T, Schubert M, Miklitz B, et al. Transforaminal posterolateral endoscopic discectomy with or without the combination of a lowdose chymopapain: a prospective randomized study in 280 consecutive cases. Spine (Phila Pa 1976),2006,31(24):890-897.
[11]魏鑫鹏,崔传广,颜廷卫,等.椎板间入路与椎间孔入路内窥镜椎间盘切除术治疗L5~S1椎间盘突出症的比较.中国矫形外科杂志,2018,26(13):1177-1182.
[12]Choi G, Lee SH, Raiturker PP, et al. Percutaneous endoscopic interlaminar discectomy for intracanalicular disc herniations at L5-S1 using a rigid working channel endoscope. Neurosurgery,2006,58(1 Suppl):ONS59-68.
[13]Ahn Y. Percutaneous endoscopic decompression for lumbar spinal stenosis. Expert Rev Med Devices,2014,11(6):605-616.
[14]Ahn Y, Kim CH, Lee JH, et al. Radiation exposure to the surgeon during percutaneous endoscopic lumbar discectomy: a prospective study. Spine (Phila Pa 1976),2013,38(7):617-625.
[15]王冰.腰椎完全内镜经椎板间入路技术的临床教程.山东大学学报（医学版）,2019,57(5):23-29.
[16]徐峰,徐彬,李涛,等.经皮内镜下腰椎间盘切除术围手术期并发症的临床研究.中国矫形外科杂志,2018,26(1):17-21.
[17]Tu Z, Li YW, Wang B, et al. Clinical outcome of fullendoscopic interlaminar discectomy for singlelevel lumbar disc herniation: a minimum of 5year followup. Pain Physician,2017,20(3):425-430.

备注/Memo

备注/Memo:
基金项目：国家自然科学基金（81871818）**通讯作者，Email:pasmiss2012@163.com
更新日期/Last Update: 2021-03-03