摘要
目的探讨经皮全内镜技术治疗75岁以上高龄节段性腰椎管狭窄症患者的早期临床疗效。方法 2014年1月至2015年12月,我院采用全内镜技术治疗12例高龄腰椎管狭窄症患者,其中男4例、女8例,年龄75~88岁,平均(81.5±6.5)岁,其中经椎间孔入路7例,经椎板间入路5例。术后第2天复查腰椎CT或MRI评估椎管减压的情况。记录术前、术后1天、3个月、6个月、12个月各时间点的疼痛视觉模拟评分(visual analogue scale,VAS)及Oswsetry功能障碍指数(oswestry disability index,ODI),并进行统计学分析比较术前及术后各时间点的差异;参照改良MacNab标准评价临床疗效。结果 12例顺利完成手术,无永久性神经损伤、感染等手术并发症发生,1例出现术后脑脊液漏出现低颅压性头痛,术后4天明显缓解;手术时间45~125 min,平均85 min,术中出血量(45.5±14.5) ml,住院时间4~7天,平均5.5天。所有纳入患者均获得1年以上随访,随访时间(18±6)个月。腰腿痛VAS评分术前为(7.50±1.50)分,术后第1天为(2.50±0.50)分,术后3个月为(2.00±1.00)分,术后6个月为(1.80±0.50)分,术后12个月为(1.50±0.50)分;ODI术前为(54.50±15.50)分,术后第1天为(22.00±14.50)分,术后3个月为(19.50±10.50)分,术后6个月为(13.50±9.00)分,术后12个月为(10.50±8.50)分。术后各时间随访VAS及ODI均较术前改善,差异有统计学意义(P<0.05)。改良MacNab疗效评价:优4例(33.3%),良6例(50.0%),可2例(17.7%),无差评,总体优良率为83.3%(10/12),患者性别、年龄、术前VAS评分、ODI功能指数及全内镜入路与改良MacNab结果无相关性(P>0.05),而术前腰腿痛病程及临床症状特点与改良MacNab结果具有相关性(P<0.05)。结论经皮全内镜技术能够明显减少手术创伤及风险,维持脊柱稳定性,缩短住院时间,降低患者治疗费用;是治疗75岁以上高龄腰椎管狭窄症患者安全、有效、微创的手术方法。
Objective To investigate the preliminary effectiveness of the percutaneous full-endoscopic on the treatment of elderly patients over 75 years old with lumbar spinal stenosis. Methods From January 2014 to December 2015, 12 elderly patients（ 4 males and 8 females） with lumbar spinal stenosis were performed percutaneous full-endoscopic surgery. The age of patients ranged from 75 years to 88 years with an average of（ 81.5 ± 6.5） years. Lumbar spine stenosis was decompressed by transforaminal approach（ 7 patients） and interlaminar approach（ 5 patients）. The lumbar CT or MRI images were reexamined 2 days after operation to evaluate the decompression of the spinal canal. The leg pain VAS scores and Oswestry Disability Index（ ODI） were recorded preoperatively and at 1 day, 3 months, 6 months and 12 months after operation. Statistical analysis was performed. The modified MacNab scores was evaluated after operation. Results The operation was successfully completed on 12 patients. There were no complications such as nerve injury or infection. One case had low intracranial pressure headache and cerebrospinal fluid leakage, but was significantly relieved 4 days after surgery. The average operation time was 85 minutes（ range： 45-125 minutes）, hospital stay 5.5 days（ range： 4-7 days）, intraoperative blood loss（ 45.5 ± 14.5） ml. All patients were followed up for more than 1 year, with a mean of（ 18 ± 6） months. The leg pain VAS score decreased from（ 7.50 ± 1.50） preoperatively to（ 2.50 ± 0.50）,（ 2.00 ± 1.00）,（ 1.80 ± 0.50） and（ 1.50 ± 0.50） at 1 day, 3, 6, 12 months after operation respectively. The ODI score also decreased from（ 54.50 ± 15.50） preoperatively to（ 22.00 ± 14.50）,（ 19.50 ± 10.50）,（ 13.50 ± 9.00） and（ 10.50 ± 8.50） at 1 day, 3, 6, 12 months after operation respectively. Statistically significant differences existed in both VAS score（ P〈0.05） and ODI score（ P〈0.05） at each postoperative follow-up time point when
作者
唐超
王高举
廖烨晖
唐强
马飞
钟德君
TANG Chao;WANG Gao-ju;LIAO Ye-hui;TANG Qiang;MA Fei;ZHONG De-jun(Department of Spine Surgery,the Affiliated Hospital of Southwest Medical University,Luzhou,Sichuan,646000,China)
出处
《中国骨与关节杂志》
CAS
2018年第10期731-737,共7页
Chinese Journal of Bone and Joint
关键词
椎管狭窄
腰椎
内窥镜
最小侵入性外科手术
Spinal stenosis
Lumbar vertebrae
Endoscopes
Minimally invasive surgical procedures
