摘要
目的 探讨可动式椎间盘镜下单侧开窗双侧减压治疗腰椎管狭窄症的疗效.方法 2007年6月至2009年6月采用可动式椎间盘镜下单侧开窗双侧减压治疗退行性腰椎管狭窄症32例,男14例,女18例;年龄56～74岁,平均65岁.均为双侧椎管狭窄合并椎间盘突出,有间歇性跛行和坐骨神经痛等症状,双下肢症状以一侧为重.在症状严重侧行棘突旁2 cm纵切口,在可动式椎间盘镜下行单侧椎板间隙开窗,神经根通道减压、突出髓核摘除;在棘突和椎板腹侧分别向上、下方用棉片压低保护硬膜囊,潜行咬除棘突基底部,在棘突基底、椎板腹侧与硬膜囊背侧之间形成工作空间,经此空间潜行咬除对侧椎板下缘和增厚的黄韧带,直至显露松解对侧神经根起始部.结果 术中无神经损伤发生,无中途转开放手术病例.发生硬膜囊撕裂2例,用棉片将其压低后完成手术.手术时间5～100min,平均70min;术中出血量50～350ml,平均150ml.术后CT示减压充分,中央椎管和对侧椎管扩大,对侧椎板、关节突和椎旁肌等结构保留完好.全部病例随访6～24个月,平均12个月.根据Macnab标准,优21例,良11例.结论 可动式椎间盘镜下单侧开窗双侧减压治疗腰椎管狭窄症操作简便,能保留对侧结构,达到双侧减压目的 ,早期随访结果优良.对双侧严重骨性狭窄者应慎用.
Objective To evaluate the feasibility and clinical efficacy of bilateral decompression via unilateral fenestration （BDUF） with mobile microendoscopic discectomy （MMED） for canal stenosis of lumbar spine. Methods From June 2007 to June 2009, 32 patients including 14 males and 18 females with an average age of 65 years （rang, 56-74 years） were treated by this technique for canal stenosis of lumbar spine. Patients complained sciatic neuralgia and intermittent claudication which was dominant in one limb. A 2 cm-incision was made beside the spinous process at the side of dominant symptom. The unilateral lamino-tomy as fenestration was performed, followed by discectomy and nerve root decompression. Then the dural theca was protected, and the base of spinous process was removed with Kerrison or high-speed burr, and a working space was made between the dural theca and the contralateral lamina. The contralateral ligament flavum and partial lamina were undercut with Kerrison, until the contralateral nerve root was released. Re-sults The procedure was technically successful in all patients. The mean operative time was 70 minutes （range, 50-100 min）, with a mean blood loss of 150 ml （range, 50-350 ml）. No significant complication was noted, only dural theca tear was encountered in two patients without obvious side effect. The postoperative CT scan revealed bilateral enlargement of canal with intact contralateral structure. The patients were followed up 12 months （range, 6 to 24 months）, and the clinical results were excellent in 21 cases, good in 11 cases according to Macnab scale. Conclusion With MMED technique, BDUF can be performed easily for lumbar canal stenosis with good clinical results; however, severe bilateral osseous stenosis may be not suitable for this technique.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2010年第6期575-578,共4页
Chinese Journal of Orthopaedics
关键词
腰椎
椎间盘移位
椎管狭窄
内窥镜检查
Lumbar vertebrae
Intervertebral disk displacement
Spinal stenosis
Endoscopy
