可视化椎间孔成形技术治疗腰椎侧隐窝狭窄症

Visualized foraminal plasty in treatment of lumbar lateral recess stenosis

摘要:

目的 分析可视化椎间孔成形技术治疗腰椎侧隐窝狭窄症的临床效果及手术技巧。方法 回顾性分析2018年1月－2019年1月52例行经皮内镜椎间孔入路椎间孔扩大成形腰椎侧隐窝减压术治疗的腰椎侧隐窝狭窄症患者的临床资料。其中，男30例，女22例，年龄63～77岁，平均（69.10±10.70）岁。记录手术时间及手术并发症，使用视觉模拟评分（VAS）和Oswestry功能障碍指数（ODI）评价手术效果，依据健康调查量表36（SF-36）评价患者生活质量，采用骨性侧隐窝角和软性侧隐窝角评估减压程度，末次随访时采用MacNab标准评估临床疗效。结果 手术时间为36～58 min，平均（43.60±17.10）min，所有患者均获得24～33个月的随访，平均（26.70±6.80）个月。术后1、3、6和12个月及末次随访时下肢痛VAS（F = 259.16，P = 0.000）及ODI（F = 162.06，P = 0.000）均较术前有明显改善。末次随访时SF-36评分为（65.94±8.75）分，较术前的（35.35±11.85）分明显提高，差异有统计学意义（P = 0.000）。术后骨性侧隐窝角为（32.62±4.67）°，软性侧隐窝角为（28.31±5.57）°，均较术前的（17.90±6.28）°和（15.02±6.52）°增大，差异均有统计学意义（P = 0.000）。末次随访时，MacNab标准评估为优39例、良10例、可3例，优良率为94.23%。结论 可视化椎间孔成形技术治疗腰椎侧隐窝狭窄症临床疗效好，对脊柱稳定性影响小，是安全、有效的微创治疗术式，值得在临床推广应用。

Abstract:

Objective To explore the clinical outcomes and surgical techniques of visualized foraminal plasty in treatment of lumbar lateral recess stenosis.Methods The medical records of 52 patients who underwent surgery for lumbar spinal stenosis from January 2018 to January 2019 were retrospectively analyzed. All these cases were performed percutaneous endoscopic transforaminal decompression, including 30 males and 22 females, the age ranged from 63 ~ 77 years, with an average of (69.10 ± 10.70) years. The operative time and complications were recorded. The clinical outcomes were assessed by visual analogue scales (VAS), Oswestry disability index (ODI) and short form 36 (SF-36). The degree of decompression was evaluated by osseous and soft lateral recess angle. The clinical effects were evaluated by MacNab scores at last follow-up.Results The operation time ranged from 36 ~ 58 min, with an average of (43.60 ± 17.10) min. All patients were followed up for 24 ~ 33 months, with a mean of (26.70 ± 6.80) months. There were significant differences between preoperation and postoperative 1, 3, 6 and 12 month and last follow-up in leg pain VAS score (F = 259.16, P = 0.000) and ODI score (F = 162.06, P = 0.000). The SF-36 score at the last follow-up was (65.94 ± 8.75), statistically higher than the preoperative score (35.35 ± 11.85). The lateral recess angle between preoperation and postoperation was significantly different [(32.62 ± 4.67)° vs (17.90 ± 6.28)°, (28.31 ± 5.57)° vs (15.02 ± 6.52)°, P = 0.000]. There were 39 excellent cases, 10 good cases and 3 fair cases according to the modified MacNab criteria, and the excellent and good rate was 94.23% at last follow-up.Conclusion Visualized foraminal plasty in the treatment of lumbar lateral recess stenosis has obvious clinical outcomes and little influence on spinal stability. It is safe, effective and worthy of promotion.