【摘要】：目的探討經(jīng)皮全脊柱內(nèi)窺鏡技術(shù)治療合并椎管內(nèi)骨化腰椎疾患的可行性有效性和安全性。方法 2008年7月—2016年6月采用全脊柱內(nèi)窺鏡技術(shù)治療96例合并椎管內(nèi)骨化的腰椎間盤突出癥或腰椎管狹窄癥患者。其中男59例,女37例;年齡13~57歲,平均29.5歲。病程3~51個(gè)月,平均18.2個(gè)月。51例有明確腰部外傷史。單節(jié)段單側(cè)癥狀92例,雙側(cè)癥狀4例。骨化性質(zhì)為椎體后緣離斷癥89例,纖維環(huán)或后縱韌帶骨化7例。骨化為側(cè)方型32例,中央型13例,混合型51例。鏡下去除致壓因素,如突出的髓核增生黃韌帶關(guān)節(jié)囊或上關(guān)節(jié)突骨贅結(jié)構(gòu)。椎間孔入路50例采用局麻或持續(xù)硬膜外麻醉,椎板間入路46例采用持續(xù)硬膜外麻醉或全麻。術(shù)前及末次隨訪時(shí)采用疼痛視覺模擬評分(VAS)評價(jià)下肢疼痛程度,末次隨訪時(shí)根據(jù)改良Macnab標(biāo)準(zhǔn)評定手術(shù)療效。結(jié)果患者手術(shù)均順利完成。經(jīng)椎間孔入路者手術(shù)時(shí)間平均53 min,術(shù)中透視次數(shù)平均8次;經(jīng)椎板間入路者分別為58 min和3次。術(shù)后臥床時(shí)間平均6.5 h,住院時(shí)間平均4.7 d。術(shù)后患者均獲隨訪,隨訪時(shí)間6~18個(gè)月,中位時(shí)間11個(gè)月。術(shù)后3 d腰椎CT三維重建示,骨化組織未切除26例,部分切除12例,完全切除49例;術(shù)后3個(gè)月腰椎MRI示硬膜囊及神經(jīng)根未見壓迫。末次隨訪時(shí)下肢疼痛VAS評分為(0.7±1.1)分,較術(shù)前的(5.8±1.1)分顯著降低(t=1.987,P=0.025);根據(jù)改良Macnab標(biāo)準(zhǔn)評價(jià)獲優(yōu)87例、良5例、可4例,優(yōu)良率95.8%。結(jié)論全脊柱內(nèi)窺鏡治療合并椎管內(nèi)骨化腰椎疾患有效、安全、微創(chuàng),近期療效可靠。骨化處理方式應(yīng)結(jié)合癥狀、影像、風(fēng)險(xiǎn)評估結(jié)果綜合分析。
[Abstract]:Objective to investigate the feasibility of percutaneous total spinal endoscopy in the treatment of lumbar spondylosis complicated with intraspinal ossification. Effectiveness and safety. Methods from July 2008 to June 2016, 96 patients with lumbar disc protrusion or lumbar spinal stenosis complicated with intraspinal ossification were treated with total spinal endoscopy. There were 59 males and 37 females with an average age of 29.5 years. The course of disease was 3 鈮，

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