Delta大通道内镜下经皮单侧椎板间入路270°环形椎管减压治疗老年腰椎管狭窄症
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作者Author单位AddressE-Mail
王贺辉 WANG He-hui 宁波市第一医院骨科, 浙江 宁波 315010 Department of Orthopaedics, the First Hospital of Ningbo, Ningbo 315010, Zhejiang, China  
夏冬冬 XIA Dong-dong 宁波市第一医院骨科, 浙江 宁波 315010 Department of Orthopaedics, the First Hospital of Ningbo, Ningbo 315010, Zhejiang, China drdongdongxia@163.com 
吴小川 WU Xiao-chuan 宁波市第一医院骨科, 浙江 宁波 315010 Department of Orthopaedics, the First Hospital of Ningbo, Ningbo 315010, Zhejiang, China  
胡佰文 HU Bai-wen 宁波市第一医院骨科, 浙江 宁波 315010 Department of Orthopaedics, the First Hospital of Ningbo, Ningbo 315010, Zhejiang, China  
期刊信息:《中国骨伤》2023年,第36卷,第11期,第1070-1074页
DOI:10.12200/j.issn.1003-0034.2023.11.012
基金项目:
中文摘要:

目的:探讨Delta大通道内镜下经皮单侧椎板间入路270°环形减压治疗老年腰椎管狭窄症(lumbar spinal stenosis,LSS) 的临床疗效。

方法:对2018年 12月至 2021年1月采用Delta大通道内镜下经皮单侧椎板间入路270°环形减压术治疗的29例LSS进行回顾性分析,其中男12例,女17例;年龄63~83(71.52±10.82)岁;患者均伴有明确的间歇性跛行,以双下肢神经源性症状为主;均为单节段椎管狭窄,L3,4 5例,L4,5 21例,L5S1 3例。采用疼痛视觉模拟评分(visual analogue scale,VAS),Oswestry功能障碍指数(Oswestry disability index,ODI)和改良Macnab评定标准分别对疼痛,下腰痛功能障碍指数及临床疗效进行评价。

结果:29例手术均顺利完成,且获得12个月以上的随访。手术时间(73.45±5.89) min,术中出血量(9.93±0.83) ml,住院时间(4.03±0.41) d。术前、术后1 d及术后1、3、12个月时腰痛VAS分别为(2.31±0.88)、(1.45±0.62)、(1.21±0.61)、(1.10±0.55)、(1.03±0.49)分:腿痛VAS分别为(6.48±0.56)、(1.97±0.61)、(1.31±0.59)、(1.17±0.59)、(1.10±0.55)分;ODI评分分别为(38.41±2.74),(18.14±1.17),(5.17±0.53),(5.07±0.45),(4.90±0.48)分;腰腿痛VAS、ODI评分术前与术后各随访时间节点比较,差异均有统计学意义(P<0.05)。术后1年按改良Macnab标准评定疗效,结果优22例,良5例,可2例。

结论:Delta大通道内镜下经皮单侧椎板间入路270°环形椎管减压治疗老年腰椎管狭窄症临床疗效满意,具有创伤小、出血少、镜下操作空间大、减压充分、术后恢复理想等优点,同时最大程度地减少了对腰椎稳定结构的破坏,是一种治疗老年腰椎管狭窄症的理想术式。
【关键词】经皮椎板间入路  单侧椎板间入路  Delta大通道内镜  环形减压  腰椎管狭窄症
 
Unilateral interlaminar approach 270° circular spinal canal decompression under the iLESSYS Delta for the treatment of lumbar spinal stenosis in the elderly
ABSTRACT  

Objective To investigate the clinical effect of unilateral interlaminar approach 270° circular spinal canal decompression under the Interlaminar Endoscopic Surgical System(iLESSYS) Delta for the treatment of lumbar spinal stenosis (LSS) in the elderly.

Methods Total of 29 patients with LSS treated with the iLESSYS Delta from December 2018 to January 2021 were retrospectively analyzed,including 12 males and 17 females with an average age of (71.52±10.82) years old ranging from 63 to 83 years old. All patients had definite intermittent claudication,mainly neurogenic symptoms of both lower limbs. All patients had single-level spinal stenosis,including L3,4 5 cases,L4,5 21 cases,and L5S1 3 cases. Visual analogue scale (VAS),Oswestry Disability Index (ODI) and modified Macnab assessment criteria were used to evaluate pain,low back pain dysfunction index and clinical efficacy,respectively.

Results All 29 cases were successfully completed. The operation time was (73.45±5.89) min,the intraoperative blood loss was (9.93±0.83) ml,the hospital stay was (4.03±0.41) days,and the follow-up was more than 12 months. The VAS scores of low back pain before surgery and 1 day,1 month,3 months,1 year after surgery were 2.31±0.88,1.45±0.62,1.21±0.61,1.10±0.55,1.03±0.49;VAS of leg pain were 6.48±0.49 0.56,1.97±0.61,1.31±0.59,1.17±0.59,1.10±0.55;ODI scores were 38.41±2.74,18.14±1.17,5.17±0.53,5.07±0.45,4.90±0.48;low back and leg pain VAS score and ODI score have statistically significant differences between preoperative and postoperative follow-up time points (P<0.05). The MacNab efficacy evaluation at 1-year follow-up:excellent in 22 cases,good in 5 cases and fair in 2 cases.

Conclusion The clinical effect of unilateral interlaminar approach 270° circular spinal canal decompression under the iLESSYS Delta for the treatment of lumbar spinal stenosis in the elderly is satisfactory,with the advantages of less trauma and less bleeding,large microscopic operation space,sufficient decompression,and ideal post-operative recovery,and at the same time,it can minimize the damage to the stable structure of the lumbar spine,which is an ideal surgical method for the treatment of elderly lumbar spinal stenosis.
KEY WORDS  Percutaneous interlaminar approach  Unilateral interlaminar approach  Inter laminar endoscopic surgical system(iLESSYS) Delta  Circular decompression  Lumbar spinal stenosis
 
引用本文,请按以下格式著录参考文献:
中文格式:王贺辉,夏冬冬,吴小川,胡佰文.Delta大通道内镜下经皮单侧椎板间入路270°环形椎管减压治疗老年腰椎管狭窄症[J].中国骨伤,2023,36(11):1070~1074
英文格式:WANG He-hui,XIA Dong-dong,WU Xiao-chuan,HU Bai-wen.Unilateral interlaminar approach 270° circular spinal canal decompression under the iLESSYS Delta for the treatment of lumbar spinal stenosis in the elderly[J].zhongguo gu shang / China J Orthop Trauma ,2023,36(11):1070~1074
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