摘要
[目的]探讨后路显微内窥镜(microendoscopy,ME)治疗胸腰椎椎管内骨性占位继发椎管狭窄症的疗效及可行性。[方法]2006年10月~2016年09月于本院行MED术治疗胸、腰椎椎管内骨性占位继发椎管狭窄症214例,其中钙化型腰椎间盘突出症153例,椎体后缘离断症17例,下位胸椎黄韧带骨化症9例,胸腰椎体爆裂骨折35例。男128例,女86例,年龄17~83岁,平均52.6岁,病程4个月~40年。单纯减压184例,内固定30例。采用JOA评分及ODI评分对术前,术后2周、3个月、6个月及1年进行评估,末次随访时采用MacNab标准评价临床效果。[结果]所有手术均顺利完成,手术时间(76.17±19.17)min,出血量(82.06±14.21)ml,平均每一切口长约(18.66±2.178)mm。1例发生脑脊液漏,2例发生一过性下肢肌力下降,1例马尾神经不全性损伤(症状侧鞍区感觉减退),以上病例经保守治疗3周左右恢复。除1例术后11 d因肺梗塞死亡,其余患者均获随访。JOA评分随着术后时间延长而显著增加,不同时间点间差异有统计学意义(P<0.05),而ODI评分随术后时间延长而显著减少,不同时间点间差异有统计学意义(P<0.05)。末次随访时,根据Macnab标准,优良率(88.19±2.16)%。[结论]MED辅助下治疗胸、腰椎椎管内骨性占位继发椎管狭窄症,可获得充分有效减压,疗效满意。
[Objective] To explore the feasibility and clinical outcomes of microendoscopy-assisted decompression for thoracolumbar stenosis secondary to intraspinal bony lesions. [Methods] From October 2006 to September 2016, we performed microendoscopy-assisted decompression in 214 patients with thoracolumbar stenosis secondary to intraspinal bony lesions, including calcified lumbar disc protrusion in 153, posterior edge separation of the vertebral body in 17, ossification of ligamentum flavum of the lower thoracic spine in 9 and old thoracolumbar burst fracture in 35 patients. Of them, 128 males and 86 females aged from 17 to 83 years with an average of 52.6 years, and suffered from the diseases from 4 months to 40 years. All patients underwent microendoscopy-assisted decompression, including simple decompression in 184 and decompression combined with internal fixation in 30 patients.The Japanese Orthopaedic Association（JOA）score, Oswestry Disability Index（ODI） and Macnab criterion were used for evaluation of the consequences. [Results] All patients had operation conducted smoothly with operation time of（76.17±19.17） mins, blood loss of（82.06±14.21）ml and incision length on average of（18.66±2.178） mm. In terms of intraoperative complication, 1 patient got cerebrospinal fluid leakage, 2 had temporary muscle weakness, 1 had incomplete injury of caudaequina with hypoesthesia to the perineumon the affected side, the other patients recovered entirely by conservative therapy for 3 weeks. All the patients were followed up except one who died of pulmonary embolism at 11 days after operation. The JOA scores significantly increased over time after operation with a statistical difference among time points（P〈0.05）, conversely, the ODI considerably decreased as time elapsed also with a statistical difference among time points（P〈0.05）. At the latest follow up, the clinical results were graded as excellent and good in（88.16±2.16）% of the patients. [Conclusion] Microendoscopy-assisted decompression
作者
王宇鹏
银和平
吴一民
李树文
杜志才
白明
孟格栋
赵健
WANG Yu-peng,YIN He-ping,WU Yi-min,LI Shu-wen,DU Zhi-cai,BAI Ming,MENG Ge-dong,ZHAO Jian(Department of Spine Surgery, The Second Affiliated Hospital, Inner MongoliaMedical University, Huhehaote 010030, Chin)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2018年第9期774-780,共7页
Orthopedic Journal of China
关键词
后路显微内窥镜术
胸腰椎
椎管内骨性占位
继发椎管狭窄症
posterior microendoscopy, thoracolumbar spine, intraspinal bonyoccupying lesion, seconda~ spinal stenosis
