摘要
目的探讨经皮全脊柱内窥镜技术治疗合并椎管内骨化腰椎疾患的可行性﹑有效性和安全性。方法 2008年7月—2016年6月采用全脊柱内窥镜技术治疗96例合并椎管内骨化的腰椎间盘突出症或腰椎管狭窄症患者。其中男59例,女37例;年龄13~57岁,平均29.5岁。病程3~51个月,平均18.2个月。51例有明确腰部外伤史。单节段单侧症状92例,双侧症状4例。骨化性质为椎体后缘离断症89例,纤维环或后纵韧带骨化7例。骨化为侧方型32例,中央型13例,混合型51例。镜下去除致压因素,如突出的髓核﹑增生黄韧带﹑关节囊或上关节突骨赘结构。椎间孔入路50例采用局麻或持续硬膜外麻醉,椎板间入路46例采用持续硬膜外麻醉或全麻。术前及末次随访时采用疼痛视觉模拟评分(VAS)评价下肢疼痛程度,末次随访时根据改良Macnab标准评定手术疗效。结果患者手术均顺利完成。经椎间孔入路者手术时间平均53 min,术中透视次数平均8次;经椎板间入路者分别为58 min和3次。术后卧床时间平均6.5 h,住院时间平均4.7 d。术后患者均获随访,随访时间6~18个月,中位时间11个月。术后3 d腰椎CT三维重建示,骨化组织未切除26例,部分切除12例,完全切除49例;术后3个月腰椎MRI示硬膜囊及神经根未见压迫。末次随访时下肢疼痛VAS评分为(0.7±1.1)分,较术前的(5.8±1.1)分显著降低(t=1.987,P=0.025);根据改良Macnab标准评价获优87例、良5例、可4例,优良率95.8%。结论全脊柱内窥镜治疗合并椎管内骨化腰椎疾患有效、安全、微创,近期疗效可靠。骨化处理方式应结合症状、影像、风险评估结果综合分析。
Objective To investigate the feasibility, effectiveness, and security of percutaneous endoscopic spine surgery for treatment of lumbar spine disorders with intraspinal ossification. Methods Between July 2008 and June 2016,96 patients with lumbar spine disorders（lumbar disc herniation or lumbar spinal stenosis） with intraspinal ossification were treated with percutaneous endoscopic spine surgery. There were 59 males and 37 females, aged from 13 to 57 years（mean, 29.5 years）. The disease duration was 3-51 months（mean, 18.2 months）. Fifty-one cases had trauma history.Ninety-two cases were single segmental unilateral symptom, 4 cases were bilateral symptom. The ossification property was posterior ring apophysis separation in 89 cases, and ossification of the fibrous ring or posterior longitudinal ligament in7 cases. There were 32 cases of lateral type, 13 cases of central type, and 51 cases of mixed type. The pressure factors, such as nucleus pulposus, hyperplasia of the yellow ligament, joint capsule, or articular osteophyma, were removed under the microscope. Local anesthesia or continuous epidural anesthesia was performed in the transforaminal approach with50 cases, and continuous epidural anesthesia or general anesthesia was performed in the interlaminar approach with46 cases. The visual analogue scale（VAS） score was used to evaluate the degree of leg pain preoperatively and at last follow-up. The effectiveness was evaluated at last follow-up according to the modified Macnab criteria. Results Allpatients were successfully operated. Via transforaminal approach, the mean operation time was 53 minutes and the mean intraoperative fluoroscopy times was 8 times; and via interlaminar approach was 58 minutes and 3 times, respectively. The mean bed rest time after operation was 6.5 hours and the mean hospitalization time was 4.7 days. All patients were followed up 6-18 months（median, 11 months）. Postoperative lumbar CT scan and three-dimensional reconstruction after3 days of operation showed that ossif
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2017年第11期1326-1333,共8页
Chinese Journal of Reparative and Reconstructive Surgery
基金
四川省科技支撑计划资助项目(2016FZ0097)
克拉玛依市科技计划项目(JK2016-2)~~
关键词
全脊柱内窥镜
椎管内骨化
微创技术
腰椎间盘突出症
腰椎管狭窄症
Percutaneous endoscopic spine surgery
intraspinal ossification
minimal invasive
lumbar disc herniation
lumbar spinal stenosis
