[1]辛大森 程才** 王路 卢守亮 闫新彪 张晓雷.脊柱内镜可视环锯技术治疗退行性腰椎椎间孔狭窄症[J].中国微创外科杂志,2023,01(7):517-521.
　Xin Dasen,Cheng Cai,Wang Lu,et al.Application of Endoscopic Visible Ring Saw in the Treatment of Degenerative Lumbar Foraminal Stenosis[J].Chinese Journal of Minimally Invasive Surgery,2023,01(7):517-521.
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脊柱内镜可视环锯技术治疗退行性腰椎椎间孔狭窄症()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2023年7期
页码:
517-521
栏目:
临床研究
出版日期:
2023-07-25

文章信息/Info

Title:
Application of Endoscopic Visible Ring Saw in the Treatment of Degenerative Lumbar Foraminal Stenosis
作者:
辛大森 程才** 王路 卢守亮 闫新彪 张晓雷
(河北省沧州市中心医院骨一科，沧州061000)
Author(s):
Xin Dasen;  Cheng Cai;  Wang Lu;  et al.
Department of Orthopedics, Cangzhou Central Hospital, Cangzhou 061000, China
关键词:
脊柱内镜; 可视环锯; 椎间孔狭窄症
Keywords:
Endoscopic spine; Visible ring saw; Foraminal stenosis
文献标志码:
A
摘要:
目的探讨脊柱内镜可视环锯技术治疗退行性腰椎椎间孔狭窄症的临床疗效。方法回顾性分析2019年10月~2020年12月脊柱内镜可视环锯技术治疗退行性腰椎椎间孔狭窄症75例的临床资料，年龄77~89岁，平均86.5岁。均有单侧下肢神经根性症状。均为单责任节段椎间孔狭窄，责任节段L4/5 15例，L5/S1 60例。术后1个月复查腰椎X线和CT，术前及术后1、6及12个月评估腿痛视觉模拟评分(Visual Analogue Scale，VAS)和Oswestry功能障碍指数(Oswestry Disability Index，ODI)，术后12个月按照腰椎改良MacNab标准评价手术疗效。结果手术时间(50.3±6.5)min，术中无血管及神经损伤等并发症。术后1个月腰椎过伸过屈侧位X线显示椎体间水平位移值、成角位移值较术前差异无统计学意义(P>0.05)，CT显示椎间孔最大宽度及面积较术前明显增加(均P=0.000)，椎间孔最大高度较术前差异无统计学意义(P>0.05)。术后12个月按改良MacNab标准，优48例，良22例，可4例，差1例，优良率93.3%。术后1、6、12个月腿痛VAS评分和ODI较术前明显改善(均P=0.000)。结论脊柱内镜可视环锯技术治疗退行性腰椎椎间孔狭窄症的疗效满意，椎间孔扩大明显，神经减压充分，且不影响腰椎稳定性。
Abstract:
ObjectiveTo investigate the clinical effect of endoscopic visual ring saw in the treatment of degenerative lumbar foraminal stenosis.MethodsClinical data of 75 patients with degenerative lumbar foraminal stenosis treated by endoscopic visual ring saw from October 2019 to December 2020 were retrospectively analyzed. The patients aged 77-89 years old (mean, 86.5 years old). All the patients had unilateral radiculopathy and singleresponsible segmental foraminal stenosis, including 15 cases of responsible segment L4/5 and 60 cases of responsible segment L5/S1. Lumbar radiography and CT were reviewed at 1 month after surgery. The Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were assessed before surgery and at 1, 6 and 12 months after surgery. The lumbar modified MacNab criteria were used to evaluate the curative effect at 12 months after surgery.ResultsThe operation time was (50.3±6.5) min. There were no complications such as vascular or nerve injury. At 1 month after surgery, lateral Xray of lumbar hyperextension and flexion showed no statistically significant difference in the horizontal and angular displacement values between the vertebral bodies compared with the preoperative values (P>0.05). Lumbar CT showed that the maximum width and area of the foramina were significantly increased compared with the preoperative values (all P=0.000), and the maximum height of the foramina had no statistically significant difference compared with the preoperative values (P>0.05). At 12 months after operation, according to the modified MacNab criteria, 48 cases were excellent, 22 cases were good, 4 cases were fair, and 1 case was poor, the excellent and good rate being 93.3%. The VAS scores of leg pain and ODI at 1, 6 and 12 months after surgery were significantly improved compared with those before surgery (all P=0.000).ConclusionEndoscopic visual ring saw technique is satisfactory in the treatment of degenerative lumbar foraminal stenosis, with obvious foraminal enlargement, sufficient nerve decompression, and no influence on the stability of the lumbar spine.

参考文献/References:

[1]Xie P,Feng F,Chen Z,et al.Percutaneous transforaminal full endoscopic decompression for the treatment of lumbar spinal stenosis.BMC Musculoskelet Disord,2020,21(1):546.
[2]Ma W,He M,Xue Y.Diagnostic role of selective spinal nerve block in the treatment of lumbar spine diseases by percutaneous endoscopic technique.Turk Neurosurg,2021,31(4):566-573.
[3]胥少汀，葛宝丰，徐印坎，主编.实用骨科学，第4版.下册.北京：人民军医出版社，2015.2091.
[4]Lee K,Jeong HS,Park C,et al.the relationship between neural foraminal stenosis and imaging features of lumbar spine MRI in patients older than 60 years with lumbar radiculopathy.Taehan Yongsang Uihakhoe Chi,2021,82(4):862-875.
[5]Mataki K,Koda M,Yamazaki M,et al.Successful visualization of dynamic change of lumbar nerve root compression with the patient in both upright and prone positions using dynamic digital tomosynthesisradiculography in patients with lumbar foraminal stenosis:an initial report of three cases.J Clin Neurosci,2019,62:256-259.
[6]Yamada K,Aota Y,Higashi T,et al.Lumbar foraminal stenosis causes leg pain at rest.Eur Spine J,2014,23(3):504-507.
[7]Lee CK,Rauschning W,Glenn W.Lateral lumbar spinal canal stenosis:classification,pathologic anatomy and surgical decompression.Spine (Phila Pa 1976),1988,13(3):313-320.
[8]Kunogi J,Hasue M.Diagnosis and operative treatment of intraforaminal and extraforaminal nerve root compression.Spine (Phila Pa 1976),1991,16(11):1312-1320.
[9]Orita S,Inage K,Eguchi Y,et al.Lumbar foraminal stenosis,the hidden stenosis including at L5/S1.Eur J Orthop Surg Traumatol,2016,26(7):685-693.
[10]Mataki K,Koda M,Shibao Y,et al.New methods for diagnosing lumbar foraminal stenosis using dynamic digital tomosynthesis radiculography.J Clin Neurosci,2020,77:106-109.
[11]Yeung A,Gore S.Endoscopic foraminal decompression for failed back surgery syndrome under local anesthesia.Int J Spine Surg,2014,8:22.
[12]Tender GC，Baratta RV，Voorhies RM．Unilateral removal of pars interarticularis．J Neurosurg Spine,2005,2(3):279-288．
[13]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.
[14]Arif S,Brady Z,Enchev Y,et al.Minimising radiation exposure to the surgeon in minimally invasive spine surgeries:a systematic review of 15 studies.Orthop Traumatol Surg Res,2021,107(7):102795.
[15]宋偲茂,熊小明,万趸,等.可视环锯在经椎间孔镜术中的有效性和安全性.中国矫形外科杂志,2021,29(1):18-22.
[16]钱军,余水生,刘建军,等.全脊柱内镜下椎间孔成型对腰椎生物力学的影响.中华医学杂志,2018,98(13):1013-1018.
[17]Dowling A,Lewandrowski KU,daSilva FHP,et al.Patient selection protocols for endoscopic transforaminal,interlaminar,and translaminar decompression of lumbar spinal stenosis.J Spine Surg,2020,6(Suppl 1):S120-S132.
[18]Enyo Y,Yamada H,Kim JH,et al.Microendoscopic lateral decompression for lumbar foraminal stenosis:a biomechanical study.J Spinal Disord Tech,2014,27(5):257-262.

备注/Memo

备注/Memo:
基金项目：河北省医学科学研究课题计划(20210205)；沧州市重点研发计划指导项目(172302139)**通讯作者，Email：cchos@qq.com
更新日期/Last Update: 2023-10-10