摘要
目的探讨应用经椎板下内窥镜外科手术系统(ULESS)治疗腰椎侧隐窝狭窄症的可行性、有效性,并分析其近期临床疗效。方法 2015年7月—2017年7月,采用ULESS治疗腰椎侧隐窝狭窄症患者38例,所有患者均为单节段、单侧症状为主,神经根腹背侧同时存在致压因素。术前及术后即刻、2周、1个月、3个月、6个月、1年采用疼痛视觉模拟量表(VAS)评分评价患者下肢疼痛程度,术后1年应用MacNab疗效评定标准评价患者临床疗效。结果所有手术均顺利完成,术后无严重并发症发生。单节段平均手术时间79.5 min,术中平均透视20.5次。所有患者术后随访1230(18.35±1.49)个月,术后即刻下肢痛VAS评分(2.72±1.38)分、术后2周(1.69±1.08)分、术后1个月(1.62±0.94)分、术后3个月(1.20±0.71)分、术后6个月(0.86±1.12分)、术后1年(0.62±1.01)分,与术前(7.31±1.14)分相比差异有统计学意义(P <0.05)。术后1年改良MacNab疗效评定:优27例,良8例,可3例,优良率为92.1%。结论对于神经根腹背侧同时存在致压因素的单节段、单侧症状为主的腰椎侧隐窝狭窄症,采用ULESS治疗可获得满意疗效。
Objective To explore the feasibility and effectiveness of underlaminar endoscopic surgical system(ULESS) for lumbar lateral recess stenosis,and analyze its short-term clinical efficacy. Methods From July 2015 to July 2017,38 patients with lumbar lateral recess stenosis were operated with ULESS. All the patients were of single segmental unilateral symptoms,with compression factors in ventral and dorsal sides of the nerve root. The visual analog scale(VAS) scores was used to evaluate the severity of lower limb pain in patients at pre-operation,immediately,2 weeks,1month,3 months,6 months and 1 year after operation. The MacNab criteria was used to evaluate clinical efficacy at 1 year after operation. Results All the operations were successfully completed without serious complications. The mean operation time of single segment was 79.5 min and the mean fluoroscopy was 20.5 times. All the patients were followed up for 12 - 30(18.35±1.49)months. Immediately, 2 weeks,1month,3 months,6 months and 1 year post-operation,the lower limb pain VAS score were 2.72±1.38,1.69±1.08, 1.62±0.94,1.20±0.71,0.86±1.12 and 0.62±1.01 respectively,significantly lower than that of the pre-operation(7.31±1.14, P < 0.05). Excellent and good outcome rate achieved 92.1% at postoperative 1 year according to MacNab criteria(27 cases in excellent,8 in good,and 3 in fair). Conclusion For lumbar lateral recess stenosis with single-segmental and unilateral symptoms of both ventral and dorsal nerve roots,ULESS can achieve satisfactory results.
作者
李晓斐
王现海
甘琨生
LI Xiao-fei;WANG Xian-hai;GAN Kun-sheng(Department of Orthopaedics,Beijing Changping Hospital,Beijing 102200,China)
出处
《脊柱外科杂志》
2019年第2期100-104,共5页
Journal of Spinal Surgery
关键词
腰椎
椎管狭窄
内窥镜检查
外科手术
微创性
Lumbar vertebrae
Spinal stenosis
Endoscopy
Surgical procedures,minimally invasive
