显微镜下单侧入路双侧减压治疗腰椎管狭窄症△

Bilateral decompression via unilateral approach under microscope for single-segment lumbar spinal stenosis

摘要:

［目的］ 探讨显微镜辅助微创通道下单侧入路双侧减压治疗腰椎管狭窄症的疗效。［方法］ 回顾性分析 2018 年 6 月—2019 年 3 月显微镜微创通道下单侧入路双侧减压融合固定单节段退变性腰椎管狭窄症 40 例患者的临床资料。记录围手术期资料，采用下肢视觉疼痛模拟评分 （VAS）、腰椎功能障碍指数 （ODI） 和改良 Macnab 标准评价临床疗效。［结果］所有患者均顺利完成手术，无转为开放或者其他手术方式病例，手术时间 （181.33±20.21） min，术中出血量 （167.81±37.41） ml。 有 3 例硬膜破裂导致脑脊液漏，1 例神经根外膜撕裂，术中均未进行修补等处理，愈后良好。随时间推移，VAS 评分及 ODI 评分均显著降低（P<0.05）。末次随访时按改良 Macnab 标准，临床结果优良率达到 92.50%（37/40）。［结论］ 显微镜微创通道下单侧入路双侧减压治疗退变性腰椎管狭窄症临床效果良好。

Abstract:

[Objective] To explore the clinical outcomes of microscope-assisted bilateral decompression via unilateral approach for de- generative lumbar stenosis. [Methods] A retrospective study was conducted on 40 consecutive patients who underwent microscope-assisted bilateral decompression and fusion via unilateral approach for single-segment degenerative lumbar stenosis from June 2018 to March 2019. The perioperative documents were collected, whereas the visual analogue scale (VAS) for leg pain, Oswestry disability index (ODI) score and modified Macnab criteria were used for evaluation of the clinical consequences. [Results] All the patients had operation performed smoothly without change of surgical plan, with operation time of (181.33±20.21) mins, and blood loss of (167.81±37.41) ml. Of them, 3 pa- tients got cerebrospinal fluid leakage due to dural sac tear, and 1 got nerve root outer membrane tear, which were not repaired during the op- eration without adverse consequences. Both the VAS and ODI scores decreased significantly over time (P＜0.05) . At the latest follow-up, the excellent and good rate of clinical outcomes were of 92.5% (37/40) based on the modified Macnab’s criteria. [Conclusion] The micro- scope-assisted bilateral decompression via unilateral approach is effective for degenerative lumbar stenosis with characteristic of minimally invasive surgery.