显微内镜辅助保留肌肉的层间减压治疗腰椎管狭窄症：105例连续病例超过3年随访的临床结果
Microendoscopy-assisted muscle-preserving interlaminar decompression for lumbar spinal stenosis: clinical results of consecutive 105 cases with more than 3-year follow-up.
作者信息
Yoshimoto Mitsunori, Miyakawa Tsuyoshi, Takebayashi Tsuneo, Ida Kazunori, Tanimoto Katsumasa, Kawamura Shuji, Yamashita Toshihiko
机构信息
From the Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.
出版信息
Spine (Phila Pa 1976). 2014 Mar 1;39(5):E318-25. doi: 10.1097/BRS.0000000000000160.
STUDY DESIGN
A retrospective review of data collected prospectively on patients who underwent microendoscopy-assisted muscle-preserving interlaminar decompression (MILD) for lumbar spinal stenosis.
OBJECTIVE
To evaluate the clinical results including surgical invasiveness and reduction rate of facet joint with a follow-up of more than 3 years.
SUMMARY OF BACKGROUND DATA
Hatta et al reported microscopic posterior decompression procedure, MILD for lumbar spinal stenosis with reference to the cervical central approach put forth by Shiraishi. Mikami et al applied spinal microendoscopy to MILD procedure (microendoscopy-assisted MILD).
METHODS
One hundred five consecutive patients, who underwent microendoscopy-assisted MILD, participated in this study. Operative time, blood loss, visual analogue scale (VAS), serum creatine kinase and C-reactive protein, surgical complications, reduction rate of the facet joint, Japanese Orthopaedic Association score, and Short-Form 36 were evaluated.
RESULTS
The operative time was 99.3 minutes and the intraoperative bleeding was 15.7 mL on average. The mean VAS score to assess surgical site pain was 20.6 mm on postoperative day 1. The mean serum creatine kinase on postoperative day 1 and C-reactive protein on postoperative day 3 were 145.4 IU/L and 2.7 mg/dL, respectively. Surgical complications were identified in 2 cases, cauda equina injury and dural tear. The mean reduction rate of the facet joint was 3%. The follow-up rate was 83.3% and the mean follow-up period was 52.7 months. The Japanese Orthopaedic Association score improved significantly from 14.8 to 23.7 points on average. Significant improvements in Short-Form 36 were observed in all subscales except in General Health. Revision surgical procedures were performed in 8 cases at the operated level including 4 of juxtafacet cyst, 3 of disc herniation, and 1 of insufficient decompression.
CONCLUSION
Microendoscopy-assisted MILD is a minimally invasive procedure and favorable clinical results can be expected for lumbar spinal stenosis.
LEVEL OF EVIDENCE
研究设计
对前瞻性收集的接受显微内镜辅助保留肌肉的椎板间减压术（MILD）治疗腰椎管狭窄症患者的数据进行回顾性分析。
目的
评估临床结果，包括手术侵袭性以及小关节面复位率，并进行超过3年的随访。
背景数据总结
Hatta等人报道了显微后路减压手术，即参照Shiraishi提出的颈椎中央入路的腰椎管狭窄症MILD手术。Mikami等人将脊柱显微内镜应用于MILD手术（显微内镜辅助MILD）。
方法
105例连续接受显微内镜辅助MILD手术的患者参与了本研究。评估手术时间、失血量、视觉模拟评分（VAS）、血清肌酸激酶和C反应蛋白、手术并发症、小关节面复位率、日本骨科协会评分和简明健康状况调查量表（Short-Form 36）。
结果
平均手术时间为99.3分钟，平均术中出血量为15.7毫升。术后第1天评估手术部位疼痛的平均VAS评分为20.6毫米。术后第1天的平均血清肌酸激酶和术后第3天的C反应蛋白分别为145.4 IU/L和2.7 mg/dL。发现2例手术并发症，即马尾神经损伤和硬脊膜撕裂。小关节面的平均复位率为3%。随访率为83.3%，平均随访时间为52.7个月。日本骨科协会评分平均从14.8分显著提高到23.7分。除总体健康外，简明健康状况调查量表所有子量表均有显著改善。在手术节段进行了8例翻修手术，包括4例关节突囊肿、3例椎间盘突出和1例减压不足。
结论
显微内镜辅助MILD是一种微创手术，对于腰椎管狭窄症可预期良好的临床效果。
证据级别
4级。
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