| 大通道内镜经单侧入路双侧减压治疗老年腰椎管狭窄症 |
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投稿时间：2020-06-08
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| 作者 | Author | 单位 | Address | E-Mail |
| 叶丙霖 |
YE Bing-lin |
甘肃省中医药研究院, 甘肃 兰州 730050
甘肃省中医院, 甘肃 兰州 730050 |
Gansu Academy of Traditional Chinese Medicine, Lanzhou 730050, Gansu, China |
ybl6123178@126.Com |
| 王想福 |
WANG Xiang-fu |
甘肃省中医院, 甘肃 兰州 730050 |
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| 李淑玲 |
LI Shu-ling |
甘肃省中医药研究院, 甘肃 兰州 730050
甘肃省中医院, 甘肃 兰州 730050 |
Gansu Academy of Traditional Chinese Medicine, Lanzhou 730050, Gansu, China |
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| 李盛华 |
LI Sheng-hua |
甘肃省中医院, 甘肃 兰州 730050 |
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| 孙凤歧 |
SUN Feng-qi |
甘肃省中医院, 甘肃 兰州 730050 |
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| 范有福 |
FAN You-fu |
甘肃省中医院, 甘肃 兰州 730050 |
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| 李晨旭 |
LI Chen-xu |
甘肃省中医院, 甘肃 兰州 730050 |
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| 雒永生 |
and LUO Yong-sheng |
甘肃省中医院, 甘肃 兰州 730050 |
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| 期刊信息：《中国骨伤》2021年，第34卷，第1期，第8-14页 |
| DOI：10.12200/j.issn.1003-0034.2021.01.003 |
| 基金项目:兰州市科学技术基金（编号：2017-4-72） |
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中文摘要:目的：评价经大通道内镜系统单侧入路双侧减压治疗腰椎管狭窄症（lumbar spinal stenosis，LSS）的临床应用效果。
方法：对2018年2月至2019年2月经大通道内镜系统单侧入路双侧减压治疗的32例LSS患者进行回顾性分析，男18例，女14例，年龄65~84（70.6±8.4）岁，病程1~12年。32例患者均伴有下肢麻木或疼痛，其中28例伴间歇性跛行，以下肢症状为著。狭窄节段：L3，4 2例，L4，5 19例，L5S1 13例，其中2例双节段狭窄。术前影像学资料显示中央管狭窄型3例，双侧侧隐窝狭窄型21例，混合狭窄型8例。记录手术用时及相关并发症发生情况，并于术后复查X线、CT和MRI；比较手术前后疼痛视觉模拟评分（visual analogue scale，VAS），Oswestry功能障碍指数（Oswestry Disability Index，ODI），单次连续步行距离（single continuous walking distance，SCWD），术后1年采用改良Macnab标准评价临床疗效。
结果：32例患者均顺利完成手术并获得随访，手术时间70~160（85.64±11.94） min，随访时间12~24（17.68±2.43）个月。术中发生硬脊膜撕裂1例，术后减压通道对侧下肢短期内感觉障碍2例，均经相应处理后好转。术后影像学显示较术前责任节段的椎管明显扩大，神经根松解充分。术前及术后3 d，3个月，1年腰痛VAS评分分别为4.62±1.41，2.73±1.35，1.21±1.17，1.11±0.34；腿痛VAS评分分别为6.83±1.71，3.10±1.50，1.08±0.19，0.89±0.24。腰腿痛VAS评分术后各时间点与术前比较，差异均有统计学意义（P<0.05）；术后3个月与术后3 d比较，差异也有统计学意义（P<0.05）；术后1年与术后3个月比较，差异无统计学意义（P>0.05）。术前及术后3 d，3个月，1年ODI评分分别为38.40±6.48，18.42±2.40，5.48±0.77，3.05±0.28；SCWD分别为（47.48±5.32） m，（52.89±11.23） m，（245.43±18.94） m，（468.97±55.87） m。ODI评分及SCWD术后各时间点与术前比较，差异均有统计学意义（P<0.05）；术后3个月与术后3 d及术后1年比较，差异也均有统计学意义（P<0.05）。术后1年采用Macnab标准评价疗效，结果优15例，良14例，可3例。
结论：采用大通道后路经皮全脊柱内镜技术单侧入路双侧减压治疗LSS是安全、有效的术式，具有减压充分，创伤小、恢复快、安全性高及术后并发症发生率低等优点，可最大限度减少对腰椎稳定结构的破坏，是一种治疗腰椎管狭窄症的理想微创手术。 |
| 【关键词】腰椎 椎管狭窄 外科手术,内窥镜 减压术,外科 |
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| Treatment of senile lumbar spinal stenosis by unilateral approach and bilateral decompression with large channel endoscopy |
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ABSTRACT Objective: To evaluate clinical effect of unilateral approach and bilateral decompression via large channel endoscopic system for the treatment of lumbar spinal stenosis.
Methods: The clinical data of 32 patients with lumbar spinal tenosis treated by unilateral approach and bilateral decompression via large channel endoscopy from February 2018 to February 2019 were retrospectively analyzed. There were 18 males and 14 females,aged 65 to 84 years old with an average of (70.6±8.4) years. The course of disease was from 1 to 12 years. All 32 cases were accompanied by numbness or pain in the lower limbs,of which 28 cases were accompanied by intermittent claudication. Narrow segments were L3,4 of 2 cases,L4,5 of 19 cases,L5S1 of 13 cases,including double segments of 2 cases. Preoperative imaging showed 3 cases of central canal stenosis,21 cases of bilateral lateral recess stenosis and 8 cases of mixed stenosis. Operation time and complications were recorded. X-ray,CT and MRI were analyzed at 3 days,3 months and 1 year after operation. Visual analogue scale(VAS),Oswestry Disability Index(ODI),single continuous walking distance(SCWD) were observed before and after operation. Modified Macnab standard were used to evaluate the clinical effect at 1 year after operation.
Results: All the patients were followed up for 12-24(17.68±2.43) months and all operations were successfully completed with the operation time of 70-160(85.64±11.94) min. Spinal dural tear occurred in 1 case during the operation,and sensory disturbance in the other side of lower limb in a short period of time occurred in 2 cases,all improved after corresponding treatment. Postoperative imaging showed that the spinal canal was significantly enlarged and the nerve root was fully released. Before operation and 3 days,3 months,1 year after operation,VAS scores of low back pain were 4.62±1.41,2.73±1.35,1.21±1.17,1.11±0.34,respectively;VAS scores of leg pain were 6.83±1.71,3.10±1.50,1.08±0.19,0.89±0.24,respectively. VAS scores of low back pain and leg pain each time point after operation were obvious improved (P<0.05); there was significant difference between 3 months and 3 days after operation(P<0.05),and there was no significant difference between 3 months and 1 year after operation(P>0.05). Before operation and 3 days,3 months,1 year after operation,ODI scores were 38.40±6.48,18.42±2.40,5.48±0.77,3.05±0.28,respectively; SCWD was (47.48±5.32) m,(52.89±11.23) m,(245.43±18.94) m,(468.97±55.87) m,respectively. The differences in ODI score and SCWD postoperative time points were statistically significant compared with those before operation (P<0.05). The difference between 3 months and 3 days after operation was statistically significant (P<0.05). The difference between 1 year and 3 months after operation was statistically significant (P<0.05). According to Macnab standard to evaluate clinical effect at 1 year after operation,15 cases got excellent results,14 good,3 fair.
Conclusion: It is a safe and effective way to treat lumbar spinal stenosis with unilateral approach and bilateral decompression via large channel endoscopic system. It has the advantages of sufficient decompression,less trauma,fast recovery,high safety and low incidence of postoperative complications. It can minimize the damage to the stable structure of the lumbar spine and is an ideal minimally invasive operation for the treatment of lumbar spinal stenosis. |
| KEY WORDS Lumbar vertebrae Spinal stenosis Surgical procedures,endoscopic Decompression,surgical |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 叶丙霖,王想福,李淑玲,李盛华,孙凤歧,范有福,李晨旭,雒永生.大通道内镜经单侧入路双侧减压治疗老年腰椎管狭窄症[J].中国骨伤,2021,34(1):8~14 |
| 英文格式: | YE Bing-lin,WANG Xiang-fu,LI Shu-ling,LI Sheng-hua,SUN Feng-qi,FAN You-fu,LI Chen-xu,and LUO Yong-sheng.Treatment of senile lumbar spinal stenosis by unilateral approach and bilateral decompression with large channel endoscopy[J].zhongguo gu shang / China J Orthop Trauma ,2021,34(1):8~14 |
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