目的 探讨多节段腰椎退变疾病的责任节段判定及经皮内镜减压的治疗效果。方法 回顾性分析2015-01至2018-12解放军总医院第三医学中心骨三科及北京电力医院骨二科诊疗的53例多节段腰椎退变疾病患者。术前先采用症状、体征和影像学分析相结合的方法来明确责任节段,若无法通过此法明确责任节段,则采用选择神经根封闭明确责任节段,然后将所有明确责任节段的患者采用经皮内镜下责任节段减压治疗。详细记录每例手术的时间、并发症发生情况、术中出血量,使用疼痛视觉模拟评分(VAS)评定手术前后的腰腿痛变化情况,改良MacNab标准评定疗效,Oswestry功能障碍指数(ODI)评价腰椎功能。结果 21例可通过症状、体征和影像学分析以确定责任节段。32例行选择神经根封闭,其中,2例未明确责任节段,未纳入研究,其余30例明确了责任节段,其准确性在减压手术中也得到了证实。所有确定责任节段的51例均顺利完成了经皮内镜下责任节段减压治疗术,手术平均时间为76.8(58~150)min,未出现神经根损伤、感染及局部血肿、硬膜囊破裂、术后椎体失稳。所有患者都定期随访,随访平均时间为18.3(12~47)个月。与手术前相比,术后7 d、3、6和12个月时的VAS评分和ODI评分均明显降低,差异有统计学意义(P<0.01)。改良Macnab标准疗效评价:优21例,良23例,可5例,差2例,优良率为86.3%。结论 选择性神经根封闭对腰椎多节段退变患者的责任节段判定简单可靠。内镜下责任节段减压治疗多节段腰椎退变疾患安全可行,创伤小,效果佳。
Abstract
Objective To investigate the diagnosis of the responsible segment and the effectiveness of percutaneous endoscopic decompression against multi-segmental lumbar degenerative diseases. Methods Fifty-three cases of multi-segmental lumbar degenerative diseases treated between January 2015 and December 2018 were retrospectively analyzed. The responsible segments of all the patients were identified using one of the two methods. The first method involved analysis of the symptoms,signs and images to detect the responsible segment that resulted in low back or leg pain. The second involved using the selective nerve root block(SNRB) to identify the responsible segment before operation. All the patients with clearly-defined responsible segments were then treated with percutaneous endoscopic decompression. The duration of surgery,intraoperative blood loss,and complications were recorded. The clinical outcome was evaluated according to the visual analogue scale (VAS),the Oswestry disability index (ODI),and the modified MacNab criterion. Results The responsible segments of twenty-one of the patients were identified with the first method. The rest received SNRB,but two of these cases did not have their responsibility segments specified,so they were not included in the study. The diagnostic accuracy was confirmed during the decompression of the patients. All the fifty-one patients whose responsible segments were clearly determined underwent percutaneous endoscopic decompression and the mean duration of surgery was 76.8 (58-150 ) minutes .There were no such complications as nerve injury,hematoma,incision infection,dural tear,or lumbar instability. All the patients were followed up for an average of 18.3 (12-47) months. The VAS and ODI at 7 days,3 months,6 months,and l2 months after operation were significantly improved (P<0.01). According to the modified MacNab criterion,there were twenty-one excellent cases,twenty-three good cases,five fair cases and two poor cases . The rate of excellent and good cases was 86.3%. Conclusions SNRB, when used to identify the responsible segment for multi-segmental lumbar degenerative diseases before operation, is user-friendly and reliable. Percutaneous endoscopic decompression against multi-segmental lumbar degenerative diseases is safe,minimally invasive and effective.
关键词
多节段腰椎退变疾病 /
责任节段 /
选择性神经根封闭 /
微创 /
经皮内镜下减压
Key words
multi-segmental lumbar degenerative diseases /
responsible segment /
selective nerve root block /
minimally invasive /
percutaneous endoscopic decompression
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