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[椎间孔成形术精准减压治疗腰椎侧隐窝狭窄症的短期疗效]

[Short-term effectiveness of accurate decompression via foraminoplasty in treatment of lumbar lateral recess stenosis].

作者信息

Wang Yu, Kong Qingquan, Song Yueming

机构信息

Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China.

Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,

出版信息

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 Nov 15;31(11):1334-1340. doi: 10.7507/1002-1892.201705076.

Abstract

OBJECTIVE

To discuss the effectiveness and the safety of accurate decompression via foraminoplasty in treating lumbar lateral recess stenosis patients who accompanied by disk-flavum ligamentum space and bony lateral recess stenosis, and to analysis the short-term effectiveness of the surgical procedures.

METHODS

Forty-five lumbar lateral recess stenosis patients accompanied by disk-flavum ligamentum space and bony lateral recess stenosis were treated by accurate decompression via foraminoplasty between January 2013 and January 2016. There were 29 males and 16 females with a median age of 58 years (range, 42-82 years). The disease duration was 3-96 months (mean, 24.4 months). The lesion segment included L in 36 cases and L , S in 9 cases. The visual analogue scale (VAS) score of low back pain and leg pain at preoperation and last follow-up were recorded, and the modified Macnab criteria was used to evaluate the effectiveness at last follow-up. Postoperative CT and MRI were reviewed to evaluate the stability and decompression of the lumbar spine.

RESULTS

All operations were successfully completed. All the 45 patients were followed up 3-18 months (median, 11 months). Dural tear occurred in 2 cases during operation, bone graft removed into the spinal canal in 1 case, postoperative low back pain occurred in 5 cases, and there was no nerve root injury, hematoma formation, or other complications. The leg pain VAS score at last follow-up (0.6±1.2) was significantly improved when compared with preoperative score (5.7±1.4) ( =8.981, =0.001); and the low back pain VAS scores showed no significant difference between preoperation and last follow-up (1.5±1.3 1.7±1.4; =0.535, =0.585). According to the modified Macnab criteria, the results were excellent in 20 cases, good in 22 cases, fair in 2 cases, and poor in 1 case at last follow-up, and the excellent and good rate was 93.3%.

CONCLUSION

Accurate decompression via foraminoplasty is an effective, safe, and less invasive way for treating lumbar recess stenosis patients accompanied by disk-flavum ligamentum space and bony lateral recess stenosis.

摘要

目的

探讨经椎间孔成形术精准减压治疗伴黄韧带间隙及骨性侧隐窝狭窄的腰椎侧隐窝狭窄症患者的有效性和安全性,并分析手术的短期疗效。

方法

2013年1月至2016年1月,对45例伴黄韧带间隙及骨性侧隐窝狭窄的腰椎侧隐窝狭窄症患者采用经椎间孔成形术精准减压治疗。其中男性29例,女性16例,年龄中位数为58岁(范围42 - 82岁)。病程3 - 96个月(平均24.4个月)。病变节段包括L 36例,L 、S 9例。记录术前及末次随访时腰腿痛的视觉模拟评分(VAS),并采用改良Macnab标准评估末次随访时的疗效。复查术后CT及MRI评估腰椎稳定性及减压情况。

结果

所有手术均顺利完成。45例患者均获随访3 - 18个月(中位数11个月)。术中2例发生硬膜撕裂,1例骨块掉入椎管,术后5例出现腰痛,未发生神经根损伤、血肿形成或其他并发症。末次随访时腿痛VAS评分(0.6±1.2)较术前评分(5.7±1.4)显著改善( =8.981, =0.001);术前与末次随访时腰痛VAS评分差异无统计学意义(1.5±1.3 1.7±1.4; =0.535, =0.585)。根据改良Macnab标准,末次随访时优20例,良22例,可2例,差1例,优良率为93.3%。

结论

经椎间孔成形术精准减压是治疗伴黄韧带间隙及骨性侧隐窝狭窄的腰椎侧隐窝狭窄症患者的一种有效、安全且微创的方法。

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本文引用的文献

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Surgical and nonsurgical treatments for lumbar spinal stenosis.腰椎管狭窄症的手术及非手术治疗
Eur J Orthop Surg Traumatol. 2016 Oct;26(7):695-704. doi: 10.1007/s00590-016-1818-3. Epub 2016 Jul 25.
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Management of lumbar spinal stenosis.腰椎管狭窄症的治疗
BMJ. 2016 Jan 4;352:h6234. doi: 10.1136/bmj.h6234.
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Percutaneous endoscopic decompression for lumbar spinal stenosis.经皮内镜下减压治疗腰椎管狭窄症
Expert Rev Med Devices. 2014 Nov;11(6):605-16. doi: 10.1586/17434440.2014.940314. Epub 2014 Jul 18.
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Degenerative lumbar spinal stenosis: evaluation and management.退变性腰椎管狭窄症:评估与管理。
J Am Acad Orthop Surg. 2012 Aug;20(8):527-35. doi: 10.5435/JAAOS-20-08-527.

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