精准定位内镜减压治疗多节段腰椎管狭窄症△

Accurate location of the responsible nerve root and endoscopic decompression for multilevel lumbar spinal stenosis

摘要:

［目的］ 探讨精准定位责任神经根联合经皮脊柱内镜手术治疗多节段退行性腰椎管狭窄症 （degenerative lumbar spi- nal stenosis, DLSS）的临床疗效。［方法］回顾性分析 2018 年 6 月—2019 年 8 月在本科手术治疗 76 例多节段 DLSS 患者的临床资料。所有患者经精准定位责任神经根后，根据术前医患沟通结果分为两组：38 例行选择性开放椎管减压（开放组），38 例行内镜椎管减压（内镜组）。比较两组围手术期、随访与影像学资料。［结果］两组患者均顺利完成手术，术中均未出现严重并发症。内镜组手术时间、术中失血量、切口长度、术后早期术口 VAS 评分及住院时间均优于开放组 （P<0.05）。两组患者随访 15~28 个月，平均（20.93±3.64）个月。内镜组下地行走时间与完全负重时间均显著早于开放组（P<0.05）。随时间推移，两组患者 VAS、腰椎 JOA 和 ODI 评分均显著下降 （P<0.05），而 JOA 评分显著增加 （P<0.05）。内镜组术后 2 周及术后 3 个月腰痛 VAS、腰椎 JOA 均显著优于开放组（P<0.05），且术后 3 个月 ODI 评分优于开放组（P<0.05）。末次随访两组间 MacNab 评级差异无统计学意义（P>0.05）。影像方面，两组腰椎前凸角均显著改善（P<0.05），椎间隙高度无显著改变（P>0.05）。［结论］在明确责任神经根基础上，经皮脊柱内镜手术治疗多节段 DLSS，较开放术式恢复快、安全性高。

Abstract:

[Objective] To explore the clinical outcomes of accurate location of responsible nerve root and percutaneous endoscopic de- compression for multi- segment degenerative lumbar spinal stenosis (DLSS) . [Methods] A retrospective study was conducted on 76 pa- tients who underwent surgical treatment for multi segment DLSS in our department from June 2018 to August 2019. All patients underwent gait load test (GLT) and selective nerve root block (SNRB) for locating the responsible nerve root accurately. According to the results of pre- operative doctor-patient communication, the patients were divided into two groups. Of them, 38 patients received selective open decompres- sion (the open group), while the remaining 38 patients underwent selective endoscopic decompression (the endoscopic group). The perioper- ative, follow-up and radiographic documents were compared between the two groups. [Results] No serious complications occurred in both groups of patients during the operation. The endoscopic group was significantly superior to the open group in terms of operation time, intra- operative blood loss, early postoperative VAS score and hospital stay (P＜0.05) . The patients in both groups were followed up for15~28 months, with an average of (20.93±3.64) months. The endoscopic group resumed walking and full weight bearing activity significantly earli- er than the open group (P＜0.05) . The VAS scores of leg pain and low back pain, as well as ODI score significantly decreased (P＜0.05) , whereas the JOA score significantly increased over time in both groups (P＜0.05) . The endoscopic group was significantly superior to the open group in terms of VAS score of low back pain and lumbar JOA score at 2 weeks and 3 months postoperatively (P＜0.05) , and the ODI score at 3 months postoperatively (P＜0.05) . However, there was no a significant difference in clinical outcomes graded by MacNab’s crite- ria between the two groups at the latest follow-up (P＞0.05) . In term of imaging evaluation, the lumbar lordosis angle significantly improved (P＜0.05) , whereas intervertebral space height remained unchanged in both groups at the latest follow-up compared with those preoperative- ly (P＞0.05) . [Conclusion] On the basis of accurate location of responsible nerve root, selective percutaneous endoscopic decompression has benefits of faster recovery and higher safety over the open decompression for multi-segment degenerative lumbar spinal stenosis.