| 精准定位经皮全内镜椎板开窗减压术治疗腰椎管狭窄症941 |
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投稿时间：2019-02-14
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| 作者 | Author | 单位 | Address | E-Mail |
| 丁宇 |
DING Yu |
解放军总医院第六医学中心康复医学科, 北京 100048 |
Department of Rehabilitation Medicine, the Sixth Medical Center, PLA General Hospital, Beijing 100048, China |
cosmos_dingyu@163.com |
| 张建军 |
ZHANG Jian-Jun |
解放军总医院第六医学中心康复医学科, 北京 100048 |
Department of Rehabilitation Medicine, the Sixth Medical Center, PLA General Hospital, Beijing 100048, China |
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| 崔洪鹏 |
CUI Hong-Peng |
解放军总医院第六医学中心康复医学科, 北京 100048 |
Department of Rehabilitation Medicine, the Sixth Medical Center, PLA General Hospital, Beijing 100048, China |
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| 卢正操 |
LU Zheng-Cao |
解放军总医院第六医学中心康复医学科, 北京 100048 |
Department of Rehabilitation Medicine, the Sixth Medical Center, PLA General Hospital, Beijing 100048, China |
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| 朱凯 |
ZHU Kai |
解放军总医院第六医学中心康复医学科, 北京 100048 |
Department of Rehabilitation Medicine, the Sixth Medical Center, PLA General Hospital, Beijing 100048, China |
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| 付本升 |
FU Ben-sheng |
解放军总医院第六医学中心康复医学科, 北京 100048 |
Department of Rehabilitation Medicine, the Sixth Medical Center, PLA General Hospital, Beijing 100048, China |
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| 李雯 |
LI Wen |
解放军总医院第六医学中心康复医学科, 北京 100048 |
Department of Rehabilitation Medicine, the Sixth Medical Center, PLA General Hospital, Beijing 100048, China |
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| 董妍含 |
DONG Yan-han |
解放军总医院第六医学中心康复医学科, 北京 100048 |
Department of Rehabilitation Medicine, the Sixth Medical Center, PLA General Hospital, Beijing 100048, China |
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| 期刊信息：《中国骨伤》2019年，第32卷，第10期，第941-946页 |
| DOI：10.3969/j.issn.1003-0034.2019.10.014 |
| 基金项目: |
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中文摘要:
目的：应用精准定位全内镜下椎板开窗减压术式（full endoscopic fenestration，FE-FE）治疗腰椎管狭窄症（lumbar spinal stenosis，LSS），并探讨其临床实用性及术后疗效。
方法：参照传统开放手术中椎板开窗减压术，应用操作水介质椎板间脊柱内镜技术完成腰椎管减压。对2016年6月至2017年6月接受FE-FE手术治疗的37例LSS患者进行回顾性分析，其中男19例，女18例，年龄55～83（67.1±18.9）岁。记录手术前后视觉模拟评分（VAS）、腰椎疾患JOA评分、Oswestry功能残障量表（ODI）及SF-36生活质量量表评定分值，观察患者自觉疼痛及神经功能恢复情况，并根据JOA评分改善率对临床疗效进行评定。
结果：37例患者均获得随访，时间8～24（13.7±6.1）个月。术后VAS、JOA、ODI及SF-36分值均较术前有明显改善（P<0.05）。根据JOA评分改善率进行疗效评估，术后6个月优17例，良13例，可5例，差2例；末次随访优19例，良13例，可4例，差1例。术后影像学显示椎管容积明显扩大，临床症状有满意的改善，腰腿疼痛缓解、生活质量提高、社会活动适应性增加，无严重并发症发生。
结论：精准定位是全内镜下完成椎板开窗减压的关键，FE-FE治疗LSS创伤小、疗效肯定、安全可靠，具有较广阔应用前景。 |
| 【关键词】腰椎管狭窄症 全内镜 精准定位 椎板开窗 减压 |
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| Percutaneously full endoscopic decompressive laminectomy with precise localization for the treatment of lumbar spinal stenosis |
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ABSTRACT
Objective:To explore the feasibility of full endoscopic fenestration (FE-FE) via interlaminar approach for the treatment of lumbar spinal stenosis (LSS),and meanwhile,to analyze the related practicability and clinical outcome.
Methods:Referring to the traditional laminectomy and decompression,the lumbar spinal canal decompression was performed by using the water-medium spinal endoscopy (named FE-FE technique). Thirty-seven patients with LSS treated by FE-FE technique were retrospectively analyzed. There were 19 males and 18 females,aged from 55 to 83 years old with an average of (67.1±18.9) years. Visual analogue scale(VAS),Japanese Orthopaedic Association Scores(JOA),Oswestry Disability Index (ODI) and 36-Item Short-Form Health Survey (SF-36) were recorded. The patient's conscious pain and recovery of neurological function were observed,and the clinical efficacy was evaluated according to the improvement rate of JOA score.
Results:All 37 patients were followed up for 8 to 24 months with an average of (13.7 ±6.1) months. The postoperative follow-up and clinical evaluation for conscious pain and neurological function recovery showed that VAS,JOA,ODI and SF-36 scores were significantly improved compared with those before surgery(P<0.05). According to the improvement rate of JOA score to evaluate the clinical effects,at 6 months after opertion,the results were excellent in 17 cases,good in 13 cases,fair in 5 cases,and poor in 2 cases;and the last follow-up,the results were excellent in 19 cases,good in 13 cases,fair in 4 cases,and poor in 1 case. Postoperative imaging showed significant expansion of spine canal volume,and the followed-up clinical symptoms were improved satisfactorily,with the relief of lumbago and leg pain,improvement of daily life quality,and increased adaptability to social activities and no serious complications.
Conclusion:Precise localization is the key to complete the canal decompression under full endoscopic surgery. FE-FE technique can effectively enlarge the narrow lumbar canal with less trauma,positive efficacy,safety and reliability. FE-FE has a broad application prospect though large cases and multi-center studies need to be further carried out. |
| KEY WORDS Lumbar spinal stenosis Full endoscopy Precise localization Fenestration Decompression |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 丁宇,张建军,崔洪鹏,卢正操,朱凯,付本升,李雯,董妍含.精准定位经皮全内镜椎板开窗减压术治疗腰椎管狭窄症941[J].中国骨伤,2019,32(10):941~946 |
| 英文格式: | DING Yu,ZHANG Jian-Jun,CUI Hong-Peng,LU Zheng-Cao,ZHU Kai,FU Ben-sheng,LI Wen,DONG Yan-han.Percutaneously full endoscopic decompressive laminectomy with precise localization for the treatment of lumbar spinal stenosis[J].zhongguo gu shang / China J Orthop Trauma ,2019,32(10):941~946 |
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