摘要
[目的]探讨经皮脊柱内镜关节突定位滑移技术(guiding and sliding)治疗腰椎管狭窄症。[方法]2016年8月~2016年11月收治腰椎管狭窄症患者共计30例,均采用侧方椎间孔入路,上关节突定位滑移技术椎间孔成形术。把后纵韧带后缘线以上部分称为"up",以下部分称之为"down",采用"up-down-up"的顺序分区域减压。随访时间3个月,采用视觉疼痛模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)和改良Mac Nab疗效评定标准,对临床疗效进行分析评估。并统计透视定位次数、手术时间,与既往上关节突尖部定位的30例患者及文献资料对比。[结果]手术时间(55.00±14.60)min,术中透视(8±1.30)次,较本科原来[(90.00±15.00)min和(16±2.30)次]及其他作者报道的[(86.00±15.40)min和(37.50±7.50)次]明显减少,差异有统计学意义(P<0.05)。腰腿痛VAS评分从术前(5.43±1.24)分降至术后1 d的(1.88±0.49)分、术后3个月的(1.58±0.46)分,较术前均有明显改善(P<0.05)。ODI评分术前(43.40±18.11)分,术后1 d降至(34.87±16.02)分,术后3个月时降至(15.67±7.54)分(P<0.05)。术后3个月随访时,依据改良的Mac Nab标准评估,优良率达93.33%。[结论]经皮脊柱内镜关节突定位滑移技术治疗腰椎管狭窄症能够明显改善临床症状、减少透视次数,缩短手术时间,近期疗效满意。
[Objective] To introduce the technique of articular process guiding and sliding in percutaneous endoscopic transforaminal decompression for treatment of lumbar canal stenosis. [Methods] From August 2016 to November 2016, 36 pa- tients with lumbar canal stenosis were endoscopically treated with lateral transforaminal approach and articular process guiding and sliding technique. Gradual decompression was conducted in order of ＂up-down-up＂ , which was relative location to the posterior margin of posterior longitudinal ligament. The visual analogue scale （VAS） for back and leg pain, Oswestry disability index （ODI） and MacNab＇ s criterion were used for evaluation of the outcome. Additionally, the times of fluoroscopy, operation time and image films were compared with our previous works and the other author＇ s article. [Results] The operation lasted for an average of （55.0±14.60） min with intraoperative fluoroscopy of （8± 1.30） times, which was significantly less than our previous works [（90.00± 15.00） min and （16±2.30） times] and other author＇ s article [（86.00~ 15.40） min and （37.50±7.50） times], respec- tively. The VAS obviously decreased from （5.43±1.24） preoperatively to （1.88±0.49） at the first day postoperatively and （1.58± 0.46） three months later. Likewise, the ODI significantly reduced from （43.40± 18.11） to （34.87± 16.02） and （15.67±7.54） at cor- responding time points At 3 months after operation The excellent and good results were achieved in 93.33% of the patients in term of modified MacNab＇ s criterion. [Conclusion] The endoscopy with articular process guiding and sliding technique does get satisfactory short-term outcome for treatment of lumbar canal stenosis, with advantages of reduced times of intraoperative fluoroscopy and shortened operation time.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2018年第1期70-74,共5页
Orthopedic Journal of China
关键词
腰椎管狭窄症
脊柱内镜术
关节突定位滑移技术
椎间孔成形术
lumbar canal stenosis, percutaneous endoscopic transforaminal decompression, articular process guidingand sliding technique, foraminoplasty
