[1]范有福 王想福 叶丙霖 孙凤歧 陈伟国 张万乾.经皮椎间孔入路脊柱内镜下减压治疗高龄腰椎滑脱21例[J].中国中医骨伤科杂志,2021,29(09):46-49.
 FAN Youfu WANG Xiangfu YE Binglin SUN Fengqi CHEN Weiguo ZHANG Wanqian.21 Cases of Experience of Percutaneous Spinal Endoscopy in theTreatment of Senile Spondylolisthesis with Root Pain[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2021,29(09):46-49.
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经皮椎间孔入路脊柱内镜下减压治疗高龄腰椎滑脱21例()
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第29卷
期数:
2021年09期
页码:
46-49
栏目:
临床报道
出版日期:
2021-09-15

文章信息/Info

Title:
21 Cases of Experience of Percutaneous Spinal Endoscopy in theTreatment of Senile Spondylolisthesis with Root Pain
文章编号:
1005-0205(2021)09-0046-04
作者:
范有福1 王想福1 叶丙霖1 孙凤歧1 陈伟国1 张万乾2
1甘肃省中医院(兰州,730050)
2甘肃中医药大学
Author(s):
FAN Youfu1 WANG Xiangfu1 YE Binglin1 SUN Fengqi1 CHEN Weiguo1 ZHANG Wanqian2
1Gansu Provincial Hospital of Traditional Chinese Medicine,Lanzhou 730050,China; 2Gansu University of Traditional Chinese Medicine,Lanzhou 730000,China.
关键词:
高龄 腰椎滑脱 经皮脊柱内镜 椎间孔镜
Keywords:
advanced age spondylolisthesis percutaneous spinal endoscopy intervertebral foraminoscope
分类号:
R681.5
文献标志码:
A
摘要:
目的:探讨经椎间孔入路全脊柱内镜下上关节突成形、侧隐窝上部分减压,治疗高龄退变性腰椎滑脱的临床疗效。方法:局麻下经皮脊柱内镜经椎间孔入路行出口、行走神经根减压治疗。采用VAS、ODI评分及改良MacNab对其进行临床疗效评价。结果:本组21例患者随访6~24个月,平均随访10.5个月,平均手术时间为(56.5±8.6)min。术后患者下肢根性疼痛、根性损害表现较术前均有不同程度的改善。VAS评分术前为(7.36±1.28)分,术后3个月为(3.25±1.22)分,术后6个月为(1.25±0.33)分,术后12个月为(0.76±0.43)分。ODI评分术前为(49.8±6.5)%,术后3个月为(32.6±10.8)%,术后6个月为(20.1±5.5)%,术后12个月为(10.2±5.4)%。VAS与ODI评分差异有统计学意义(P<0.05)。末次随访采用改良MacNab评价优良率达91.2%。结论:局麻下经皮椎间孔入路内镜下神经根减压术疗效显著,无明显并发症,安全性高,疗效确定,为部分不能耐受开放手术的高龄退行性腰椎滑脱患者提供了一种安全有效的治疗方法。
Abstract:
Objective:To investigate the clinical effect of transforaminal approach to the treatment for degenerative lumbar spondylolisthesis with radicular pain under the upper articular process and decompression of the upper part of the lateral recess under total spine endoscope.Methods:Percutaneous spinal endoscopy under local anesthesia through the intervertebral foramina approach was adopted to decompress of the exit nerve root and walking nerve root.VAS,ODI score,and modified MacNab were used to evaluate its clinical efficacy.Results:The 21 patients in this group were followed up for 6 to 24 months,with an average follow-up time of 10.5 months.The average operation time was(56.5±8.6)min.The postoperative lower extremity radicular pain and radicular damage were improved to varying degrees compared with the preoperative performance.The VAS score was(7.36±1.28)points before operation,(3.25±1.22)points after 3 months,(1.25±0.33)points after 6 months,and(0.76±0.43)points after 12 months.The ODI score was(49.8±6.5)% points before operation,(32.6±10.8)% points after 3 months,(20.1±5.5)% points after 6 months,and(10.2±5.4)% points after 12 months.The difference between VAS score and ODI score was statistically significant(P<0.05).At the last follow-up,the improved MacNab was used to evaluate the excellent and good rate of 91.2%.Conclusion:Percutaneous endoscopic foraminal nerve root decompression under local anesthesia has significant curative effect,without obvious complications,and high safety.It is provided for some elderly patients with degenerative lumbar spondylolisthesis and radicular pain who cannot tolerate open surgery.It is a safe and effective treatment method.

参考文献/References:

[1] CHAKRAVARTHY V, PATEL A, KEMP W,et al.Surgical treatment of lumbar spondylolisthesis in the elderly[J].Neurosurg Clin N Am,2019,30(3):341-352.
[2] VER M L P, DIMAR J R 2ND, CARREON L Y.Traumatic lumbar spondylolisthesis:a systematic review and case series[J].Global Spine J,2019,9(7):767-782.
[3] URQUHART J C,ALNAGHMOOSH N,GURR K R,et al.Posterolateral versus posterior interbody fusion in lumbar degenerative spondylolisthesis[J].Clin Spine Surg,2018,31(9):E446-E452.
[4] YANG Z,LIU B,LAN H,et al.Comparative study on effectiveness of modified-transforaminal lumbar interbody fusion and posterior lumbar interbody fusion surgery in treatment of mild to moderate lumbar spondylolisthesis in middle-aged and elderly patients[J].Chin J Repar Reconstr Surg,2020,15,34(5):550-556.
[5] LV Z,JIN L,WANG K,et al.Comparison of effects of PELD and fenestration in the treatment of geriatric lumbar lateral recess stenosis[J].Clin Interv Aging,2019,14:2187-2194.
[6] XIONG C,LI T,KANG H,et al.Early outcomes of 270-degree spinal canal decompression by using TESSYS-ISEE technique in patients with lumbar spinal stenosis combined with disk herniation[J].Eur Spine J,2019,28(1):78-86.
[7] KOSLOSKY E, GENDELBERG D.Classification in brief:the meyerding classification system of spondylolisthesis[J].Clin Orthop Relat Res,2020,478(5):1125-1130.
[8] SENGUPTA D K, HERKOWITZ H N.Degenerative spondylolisthesis:review of current trends and controversies[J].Spine(Phila Pa 1976),2005,30(6 Suppl):S71-S81.
[9] MIYASHITA T, ATAKA H, KATO K,et al.Pedicle screw shift without loosening following instrumented posterior fusion:limitations of pedicle screw fixation[J].Neurosurg Rev,2019,42(3):691-698.
[10] 李新锋,王琨,靳林煜.脊柱内镜减压治疗高龄腰椎退变性脊柱侧凸合并神经根管狭窄[J].中国微创外科杂志,2020,20(2):151-155.
[11] STAARTJES V E, SCHR?DER M L.Effectiveness of a decision-making protocol for the surgical treatment of lumbar stenosis with grade 1 degenerative spondylolisthesis[J].World Neurosurg,2018,110:e355-e361.
[12] IRMOLA TM, H?KKINEN A, J?RVENP?? S,et al.Reoperation rates following instrumented lumbar spine fusion[J].Spine(Phila Pa 1976),2018,43(4):295-301.
[13] WEINSTEIN J N, LURIE J D, TOSTESON T D,et al.Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis[J].N Engl J Med,2007,356(22):2257-2270.
[14] HASEGAWA K, KITAHARA K, SHIMODA H,et al.Lumbar degenerative spondylolisthesis is not always unstable:clinicobiomechanical evidence[J].Spine(Phila Pa 1976),2014,39(26):2127-2135.
[15] CHAKRAVARTHY V, PATEL A, KEMP W,et al.Surgical treatment of lumbar spondylolisthesis in the elderly[J].Neurosurg Clin N Am,2019,30(3):341-352.
[16] MARTIN BI, MIRZA SK, SPINA N,et al.Trends in lumbar fusion procedure rates and associated hospital costs for degenerative spinal diseases in the united states,2004 to 2015[J].Spine(Phila Pa 1976),2019,44(5):369-376.
[17] WU K,ZHAO Y,FENG Z,et al.Stepwise local anesthesia for percutaneous endoscopic interlaminar discectomy:technique strategy and clinical outcomes[J].World Neurosurg,2020,134:e346-e352.
[18] 徐峰,伍搏宇,席金涛,等.调棒技术与常规穿刺在经皮椎间孔镜腰椎间盘切除术中的比较[J].中国微创外科杂志,2020,20(4):318-321.
[19] LEE C W,YOON K J,JUN J H.Percutaneous endoscopic laminotomy with flavectomy by uniportal,unilateral approach for the lumbar canal or lateral recess stenosis[J].World Neurosurg,2018,113(5):e129-e137.
[20] KOMP M,HAHN P,OEZDEMIR S,et al.Bilateral spinal decompression of lumbar central stenosis with the full-endoscopic interlaminar versus microsurgical laminotomy technique:a prospective,randomized,controlled study[J].Pain Physician,2015,18(1):61-70.
[21] NIE H,ZENG J,SONG Y,et al.Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation via an interlaminar approach versus a transforaminal approach:a prospective randomized controlled study with 2-year follow up[J].Spine(Phila Pa 1976),2016,41(Suppl 19):B30-B37.
[22] MO X,SHEN J,JIANG W,et al.Percutaneous endoscopic lumbar discectomy for axillar herniation at L5-S1 via the transforaminal approach versus the interlaminar approach:a prospective clinical trial[J].World Neurosurg,2019,125(5):e508-e514.

备注/Memo

备注/Memo:
基金项目:兰州市人才创新创业项目(2020-RC-54)
更新日期/Last Update: 1900-01-01