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[腰椎外侧椎管狭窄减压术:全内镜下椎板间技术]

[Decompression of lumbar lateral spinal stenosis: full-endoscopic, interlaminar technique].

作者信息

Ruetten S, Komp M, Hahn P, Oezdemir S

机构信息

Zentrum für Wirbelsäulenchirurgie und Schmerztherapie, Zentrum für Orthopädie und Unfallchirurgie der St. Vincenz Gruppe Ruhr, St. Anna Hospital Herne/Marien-Hospital Witten, Hospitalstr. 19, 44649, Herne, Deutschland.

出版信息

Oper Orthop Traumatol. 2013 Feb;25(1):31-46. doi: 10.1007/s00064-012-0195-2.

Abstract

OBJECTIVE

Decompression in lumbar recess stenosis in a full-endoscopic technique using an interlaminar approach.

INDICATIONS

Lumbar recess stenosis due to ligamentous, osseous, discogenic compression, and/or juxta-facet cysts.

CONTRAINDICATIONS

Pure back pain, instability/deformity requiring correction, pure foraminal stenosis.

SURGICAL TECHNIQUE

Introduction of a surgical sleeve to the intralaminar window. Endoscopic resection of compressing bony/ligamentary structures and also of osteophytes or parts of annulus.

POSTOPERATIVE MANAGEMENT

Immediate mobilization, isometric/coordination exercises, functional exercises from week 3, building up strength from week 6.

RESULTS

A total of 192 patients underwent full-endoscopic surgery or microsurgery and were followed up over a minimum of 2 years. A significant improvement was revealed. Serious complications occurred in 5% and were significantly reduced in the endoscopic group. Five patients were revised with decompression and/or fusion. Eighty-nine percent would undergo the operation again.

摘要

目的

采用全内镜技术经椎板间入路治疗腰椎管狭窄症。

适应证

因韧带、骨质、椎间盘源性压迫和/或关节突旁囊肿导致的腰椎管狭窄症。

禁忌证

单纯背痛、需要矫正的不稳定/畸形、单纯椎间孔狭窄。

手术技术

将手术套管插入椎板内窗口。内镜下切除压迫性骨/韧带结构以及骨赘或部分椎间盘环。

术后管理

立即活动,进行等长/协调性锻炼,从第3周开始进行功能锻炼,从第6周开始增强力量。

结果

共有192例患者接受了全内镜手术或显微手术,并至少随访2年。结果显示有显著改善。严重并发症发生率为5%,在内镜组中显著降低。5例患者接受了减压和/或融合翻修手术。89%的患者愿意再次接受该手术。

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