[1]房格 王永峰* *原杰 徐朝健 赵振鉴 王凯.联合CT参数评估大通道内镜治疗单节段腰椎管狭窄症的安置空间及疗效分析[J].中国微创外科杂志,2022,01(10):808-813.
　Fang Ge,Wang Yongfeng,Yuan Jie,et al.Combination With CT Parameters to Evaluate the Placement Space and Efficacy of Uniportal Endoscopy in the Treatment of Singlelevel Lumbar Spinal Stenosis[J].Chinese Journal of Minimally Invasive Surgery,2022,01(10):808-813.
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联合CT参数评估大通道内镜治疗单节段腰椎管狭窄症的安置空间及疗效分析()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2022年10期
页码:
808-813
栏目:
临床研究
出版日期:
2023-01-20

文章信息/Info

Title:
Combination With CT Parameters to Evaluate the Placement Space and Efficacy of Uniportal Endoscopy in the Treatment of Singlelevel Lumbar Spinal Stenosis
作者:
房格 王永峰* *原杰 徐朝健 赵振鉴 王凯
（山西医科大学第二医院骨科，太原030001）
Author(s):
Fang Ge;  Wang Yongfeng;  Yuan Jie;  et al.
Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan 030001, China
关键词:
脊柱内镜; 腰椎管狭窄症; 椎板开窗减压; 临床疗效
Keywords:
Spinal endoscope; Lumbar spinal stenosis; Lamina decompression; Clinical outcome
文献标志码:
A
摘要:
目的探讨大通道（直径10 mm）内镜的合理安置空间及内镜下椎板开窗减压术治疗腰椎管狭窄症(lumbar spinal stenosis,LSS)的临床疗效。方法回顾性分析我院2020年3月~2021年2月30例大通道内镜下椎板开窗减压术治疗单节段腰椎管狭窄症患者的资料，随访至少6个月。为评估大通道内镜的合理安置空间，以术前腰椎薄层CT数据重建腰椎三维图像，分别测量L4/5和L5/S1棘突基底部与椎板峡部距离（a），与关节突内缘距离（b），与关节突1/2距离（c），与关节突外缘距离（d）。以腰腿痛视觉模拟评分（Visual Analogue Scale，VAS）、Oswestry功能障碍指数（Oswestry Disability Index，ODI）和改良MacNab标准评价疗效。结果①CT测量L4/5、L5/S1的a值分别为(7.48±1.59)mm、(7.75±1.10)mm，b值分别为(783±1.33)mm、(7.91±1.23)mm，c值分别为(12.91±1.68)mm、(13.08±1.53)mm，d值分别为(17.39±1.64)mm、(1785±155)mm。②手术均顺利完成，手术时间(70.4±10.2) min，透视次数(4.1±1.1)次。均未变更手术方式，未出现严重并发症。随访6~18个月，（11.4±3.4）月。腰腿痛VAS评分和ODI在术后1个月、3个月及末次随访时均明显小于术前，且术后持续改善（P<0.05），改良MacNab标准，优22例，良6例，可2例，优良率93.3%（28/30）。结论应用大通道内镜开骨窗时向外磨除的骨质达到上位椎体下关节突中份时（c值），即为大通道的合理安置空间。在此范围内，大通道内镜下行腰椎椎板减压术通过有效的开窗达到了微创治疗效果。
Abstract:
ObjectiveTo investigate the reasonable placement space and the clinical efficacy of uniportal endoscopy laminectomy for lumbar spinal stenosis (LSS).MethodsThe data of 30 patients with singlelevel lumbar spinal stenosis treated by uniportal endoscopic (10 mm in diameter) laminectomy in our hospital from March 2020 to February 2021 were analyzed retrospectively and followed up for at least 6 months. In order to evaluate the reasonable placement space of uniportal endoscopy, 3D images of lumbar vertebrae were reconstructed based on preoperative thin lumbar CT data: the distance between the base of L4/5 and L5/S1 spinous processes and the isthmus of the lamina (a), the inner edge of the facet (b), the 1/2 of the facet (c), and the outer edge of the facet (d). The postoperative curative effect was evaluated according to the Visual Analogue Scale (VAS) of back and leg pain, Oswestry Disability Index (ODI) and modified MacNab criteria.Results① The CT measurement results of L4/5 and L5/S1 showed that the a values were (7.48±1.59) mm and (7.75±1.10) mm, b values were (7.83±1.33) mm and (7.91±1.23) mm, c values were (12.91±1.68) mm and (13.08±1.53) mm, and d values were (17.39±1.64) mm and (17.85±1.55) mm, respectively. ② The surgeries were all completed successfully, with an operative time of (70.4±10.2) min and fluoroscopic frequency of (4.1±1.1) times. None of the surgical procedures were changed, and no serious complications occurred. Followups period lasted 6-18 months (mean, 11.4±3.4 months). The VAS of low back pain and leg pain and ODI at 1 month, 3 months and the last followup were significantly lower than that before operation and continued to improve after surgery (P<0.05). According to the modified MacNab criteria, there were 22 cases of excellent outcomes, 6 cases of good, and 2 cases of fair, the excellent and good rate being 933% (28/30).ConclusionsWhen the bone grinded outward reaches the middle of inferior articular process of superior vertebral body (c value) in the bone window opening by uniportal endoscopy, it is a reasonable space for the placement of the uniportal endoscopy. In this range, lumbar lamina decompression under uniportal endoscopy achieves the effect of minimally invasive treatment through effective and safe fenestration.

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备注/Memo

备注/Memo:
基金项目：山西省自然科学基金（201801D121220）**通讯作者，Email：wyfwf8@163.com
更新日期/Last Update: 2023-01-20