改良置管全内镜直视下椎间孔按需成形术在腰椎管狭窄症中的应用

Clinical application of modified catheterization full-endoscopic foraminoplasty for lumbar spinal stenosis

摘要:

目的 评价改良置管全内镜直视下椎间孔按需成形术治疗腰椎管狭窄症（LSS）的临床效果。方法 选取2019年3月－2022年4月该院收治的LSS患者162例，均采用改良置管内镜直视下椎间孔按需成形术治疗。采用视觉模拟评分法（VAS）评分和Oswestry功能障碍指数（ODI），评估术前、术后3 d、术后3周和术后8个月的临床症状。末次随访时，依据MacNab标准，评估临床疗效；采用CT三维重建技术，测定椎间孔面积的变化情况。结果 所有患者随访时间为3～9个月，平均（6.35±2.25）个月。术后各时间点VAS评分和ODI较术前明显降低，差异均有统计学意义（P 0.05），MacNab优良率为86.4%；椎间孔面积由术前的（59.59±23.85）mm2，增大至术后的（156.43±27.01）mm2，改善率为162.52%。3例患者出现下肢感觉异常，经对症治疗后缓解。结论 改良置管全内镜直视下椎间孔按需成形术治疗LSS，可精准扩大操作空间，提高减压效果，降低了手术难度和并发症发生率，是一种安全、高效的治疗方案。

Abstract:

Objective To evaluate the clinical efficacy of modified catheterization full-endoscopic foraminoplasty for lumbar spinal stenosis (LSS).Methods 162 patients with LSS treated between March 2019 and April 2022 were enrolled. All patients were treated with modified catheterization full-endoscopic foraminoplasty.Visual analogue scale (VAS) scores and the Oswestry Disability Index (ODI) were assessed preoperatively, at 3 days, 3 weeks and 8 months postoperatively. Clinical efficacy was graded via the MacNab criteria at the final follow-up, and three-dimensional CT reconstruction was applied to quantify intervertebral foramen area changes.Results The mean follow-up duration was (6.35 ± 2.25) months (range: 3 ~ 9 months). Postoperative VAS scores and ODI were significantly lower than baseline values at all follow-up time points (P 0.05). The MacNab excellent and good rate reached 86.4%. The mean intervertebral foramen area increased from preoperative (59.59 ± 23.85) mm2 to postoperative (156.43 ± 27.01) mm2, with an expansion rate of 162.52%. Transient lower limb paresthesia occurred in 3 patients and resolved with conservative symptomatic management.Conclusion Modified catheterization with full-endoscopic foraminoplasty enables precise foraminal decompression, improves surgical efficiency, and reduces complication risks, representing a safe and effective minimally invasive treatment for LSS.