摘要
[目的]探讨经皮椎间孔入路内镜下治疗邻椎病的临床疗效。[方法]2014年1月~2017年12月腰椎融合术后出现邻椎病患者47例,男29例,女18例,年龄57~79岁,平均(64.91±7.12)岁。所有患者均为单侧症状。全部患者采用经皮椎间孔入路内镜减压手术,记录围手术期资料,采用Oswestry功能障碍指数(ODI)、疼痛视觉模拟评分(VAS)和MacNab标准评价临床疗效。[结果]47例患者均完成手术,手术用时49~139min,平均(59.91±32.42)min。4例穿刺过程中出现神经根刺激症状,3例术中出现硬膜囊损伤,均未造成严重不良后果。全部患者均未出现神经不可逆性损伤、椎间隙感染等相关并发症。随访12个月以上。随时间推移患者的ODI评分和VAS评分显著下降,不同时间点间差异有统计学意义(P<0.05)。末次随访时按改良MacNab标准,临床结果评定为优35例、良8例。至末次随访时,动力位影像显示5例椎间失稳。[结论]经皮椎间孔入路内镜治疗腰椎融合术后邻椎病,创伤小,临床疗效好。
[Objective]To explore the clinical outcomes of endoscopic surgery through percutaneous intervertebral foramen approach for adjacent segment diseases secondary to lumbar spine fusion.[Methods]From January 2014 to August 2017,a total of 47 patients,including 29 males and 18 females aged 57-79 years with an average of(64.91±7.12)years,underwent surgical treatment for adjacent segment diseases secondary to lumbar fusion.All patients presented unilateral symptom and received endoscopic decompression through percutaneous transforaminal approach.The perioperative data was documented,additionally,the Oswestry disability index(ODI),visual analogue scale(VAS)and the MacNab criteria were used for evaluation of the clinical consequences.[Results]All the 47 patients had surgical procedures performed smoothly with operation time of(59.91±32.42)min ranged from 49 to 139 min.Of them,4 patients had irritation of nerve roots during puncture and 3 patients got dural injuries,which did not lead to unacceptable consequences.No serious complications,such as irreversible nerve damage and intervertebral space infection occurred in anyone of them.The follow-up period lasted for more than 12 months.Both the ODI and VAS scores significantly decreased as time went,with statistical significances among the time points(P<0.05).The clinical outcome was graded as excellent in 35 patients and good in 8 patients at the latest follow up based on the MacNab criteria.To the latest follow up,the intervertebral instability was revealed in 5 patients by dynamic radiographs.[Conclusion]This endoscopic surgery through percutaneous intervertebral foramen approach for adjacent segment diseases secondary to lumbar spine fusion does achieve satisfactory clinical outcomes with minimized iatrogenic trauma.
作者
付松
吕仁花
邵诗泽
王龙强
王亚楠
邹奇
刘海军
黄相鹏
FU Song;LV Ren-hua;SHAO Shi-ze;WANG Long-qiang;WANG Ya-nan;ZOU Qi;LIU Hai-jun;HUANG Xiang-peng(Department of Spinal Cord Surgery,Shandong Wendeng Orthopaedic Hospital,Weihai 264400,China;Department of TCD,Weihai Central Hospital,Weihai 264400,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2019年第13期1163-1166,共4页
Orthopedic Journal of China
关键词
内镜
邻椎病
腰椎融合术
椎间孔入路
endoscopy
adjacent segment disease
lumbar fusion
intervertebral foramen approach
