摘要
目的探讨显微镜下经皮微通道单侧椎旁入路双侧减压术治疗腰椎椎管狭窄症的手术技巧及临床疗效。方法回顾性分析2011年11月至2015年5月福建医科大学附属协和医院神经外科收治的35例中央型腰椎椎管狭窄症的临床资料。在神经电生理监测下采用单侧椎旁入路经皮微通道系统双侧椎管减压术，分析手术切口、手术时间、术中出血量、术中神经电生理监测等指标，记录术前1d和术后1d、3d、5d肌酸磷酸激酶（CK-MM）水平；记录术前1d和术后1d、3d、5d、1个月、3个月、6个月及12个月的日本骨科学会（JOA）评分和视觉模拟量表（VAS）评分；影像学评价术前、术后1个月、6个月及末次随访的腰椎MRI、X线及CT重建。结果本组手术未出现神经损伤、脑脊液漏、感染及死亡病例；手术切口为1．5-1．8cm，手术时间为65～110min，术中出血量为8-35ml。术后1dCK-MM升高至（461．2±32．6）IU／ml，与术前相比差异有统计学意义（P〈0．05），术后5d与术前1d相比，差异无统计学意义（P〉0．05）；随访12个月，JOA由术前（13．4±3．7）分恢复至（28．1±0．8）分（P〈0．05）；VAS评分由术前（6．9±1．1）分减少至（0．4±0．5）分（P〈0．05）。术后MRI检查示神经减压充分，未见腰椎失稳症或侧弯畸形。结论显微镜下经皮微通道单侧椎旁入路双侧减压术治疗中央型腰椎椎管狭窄症疗效确切，神经减压充分，减小椎旁肌肉、关节突关节、棘突与韧带的损伤，还能兼顾术后腰椎稳定性与活动度。
Objective To evaluate the clinical outcomes and operative techniques of microscopic bilateral decompression for lumbar spinal canal stenosis via the unilateral paramedian approach with tubular retractor system. Methods A retrospective study was conducted to analyze 35 patients with central lumbar spinal canal stenosis who were admitted to Department of Neurosurgery, Affiliated Union Hospital, Fujian Medical University from November 2011 to May 2015. Bilateral spinal canal decompression was performed using microchannel percutaneous system through unilateral paraspinal approach and under intraoperative electroneurophysiological monitoring （IOEM）. Data including surgical incision, operation time, blood loss volume and IOEM were analyzed. Creatine kinase（CK-MM） levels were measured 1 day before surgery and 1 day, 3 day as well as 5 days postoperatively. The Japanese Orthopedic Association （JOA） and Visual Analog Scale （VAS） scores were documented at 1 day preoperatively, and postoperatively at day 1, day 3, day 5, month 1, month 3, month 6 and month 12 months . Lumbar magnetic resonance imaging, computed tomography （CT）, and X-ray scan were conducted preoperatively and at 1 month, 6 month and the last follow-up postoperatively. Results The operations were all successfully accomplished with no cases of nerve injury, cerebrospinal fluid leakage （ CSFL）, postoperative infection or death. The surgical incisions measured 1.5 - 1.8 cm, the operations lasted 65 - 110 min, and blood loss volumes were estimated between 8 to 35 ml. The CK-MM level was increased to（461.2± 32.6）IU/ml 1 day post-op, with a statistically significant difference compared with pre-op. （P 〈 0.05 ） and decreased to baseline level at 5 day post-op. （P 〉 0.05）. At the 12-month follow-up, the JOA score was elevated from （ 13.4 ± 3.7 ） to （28.1± 0.8 ） （P 〈 0.05） and the VAS score decreased from （6.9 ± 1.1 ） to （0.4 ±0.5 ） （ P 〈 0.05 ）. Postoperative examination of MRI indicated sufficient nerve decompression. No lumbar spinal instability or scoliosis wasobserved. Conclusion Microscopic bilateral decompression through microelectrode percutaneous approach seems effective for central lumbar spinal canal stenosis with sufficient nerve decompression and less injuries of paraspinal muscles, facet joints, spinous processes and ligaments. This technique offers the advantage of postoperative stability and preserved lumbar mobility.
出处
《中华神经外科杂志》
CSCD
北大核心
2016年第12期1208-1213,共6页
Chinese Journal of Neurosurgery
基金
基金项目：福建省自然科学基金（2015J0105）
关键词
腰椎
椎管狭窄
显微外科手术
单侧入路
双侧减压
Lumbar vertebrae
Spinal stenosis
Microsurgery
Unilateral approach
Bilateral decompression
