单侧双通道内镜治疗双节段腰椎管狭窄症

Unilateral biportal endoscopy for treatment of double-segment lumbar spinal stenosis

摘要:

［目的］介绍单侧双通道内镜治疗双节段腰椎管狭窄症的手术技术和初步临床效果。［方法］对 8 例双节段腰椎管狭窄症患者采用单侧双通道内镜技术治疗。3 个切口的横线分别通过上位椎体椎弓根的下缘、中间椎体椎弓根的中点、下位椎体椎弓根的上缘，左侧椎弓根内缘的连线与横线交点即为切口点。依次建立观察通道及操作通道，保持灌洗液出水通畅，使用磨钻、骨刀、椎板钳等器械进行椎管减压，减压完毕后进行椎间盘的切除。术后第 2 d 佩戴支具下床活动，共 2 个月。采用 VAS 评分、Oswestry 功能障碍指数和改良 Macnab 标准评价临床疗效。［结果］所有患者均顺利完成手术，手术时间平均（192.52± 14.14）min。术中硬膜囊撕裂 1 例。随访时间为 6~15 个月，平均（10.62±6.36） 个月。患者术后臀部疼或下肢放射痛的 VAS 评分及 ODI 评分均显著下降，随着时间的推移，症状缓解更加明显。末次随访时的临床疗效：优 5 例，良 2 例，可 1 例，优良率 87.50%。［结论］ 单侧双通道内镜技术是治疗双节段腰椎管狭窄症的有效方法。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of unilateral biportal endoscopy (UBE) for double-segment lumbar spinal stenosis. [Methods] A total of 8 patients underwent UBE for double-segment lumbar spinal stenosis. The horizontal line of the three incisions passed through the lower edge of the pedicle of the upper vertebral body, the midpoint of the pedicle of the middle vertebral body, and the upper edge of the pedicle of the lower vertebral body, respectively. The intersection point between the line and the horizontal line of the inner edge of the left vertebral pedicle was the incision point. The observation channel and operation chan- nel were established successively to keep the lavage fluid flowing smoothly. The spinal canal was decompressed by using bur, osteotome, rongeur and other instruments, and then the discectomy was performed. On the second day after surgery, the patient got out of bed with a brace for 2 months. The VAS score, Oswestry disability index and modified Macnab criteria were used to evaluate the clinical efficacy. [Results] All patients had operation completed successfully with operation time of (192.52±14.14) min, whereas intraoperative dural sac tear happened in only 1 case. As time went during the follow-up lasted for (10.62±6.36) months (range, 6~15 months) , the VAS score and ODI score decreased significantly (P＜0.05) , in other word, the symptom relief became more obvious. At latest follow-up, the clinical outcomes were marked as excellent in 5 cases, good in 2 cases and fair in 1 case, with an excellent and good rate of 87.5%. [Conclusion] The unilat- eral biportal endoscopy is an effective method for the treatment of double-segment lumbar spinal stenosis.