摘要
[目的]探讨经皮椎间镜下减压(PELD)治疗老年腰椎管狭窄症的安全性和临床疗效。[方法]回顾性分析2015年1月~2017年12月PELD治疗的27例老年腰椎管狭窄症患者,所有患者均存在内科合并症且全麻风险高危。采用腿痛VAS和ODI评分,以及改良MacNab评价临床疗效。腰椎MRI评估神经根受压和狭窄部位减压情况。[结果]所有患者均在局部麻醉下顺利完成手术,术中及术后无内科合并症加重或急性发作,亦无新发心脏、肺部或脑血管疾病。随访12~39个月,1例患者于术后5个月时症状加重同术前水平,再次PELD手术,术后症状好转。腿痛VAS评分由术前(8.11±0.98)分显著减少至末次随访时(0.84±0.44)分;ODI评分术前由(62.82±11.37)%显著减少至末次随访时(10.41±5.70)%,差异有统计学意义(P<0.05)。改良MacNab的优良率为85.19%。术后腰椎MRI显示神经根受压明显缓解,椎管狭窄部位减压充分。[结论]对于存在内科合并症且全麻风险高危的老年腰椎管狭窄症患者,PELD手术时间短、创伤小,且局麻下进行手术,对患者全身影响小、安全,满意度高。
[Objective]To investigate the surgical safety and clinical efficacy of percutaneous endoscopic lumbar decompression(PELD)for lumbar spinal stenosis in the elderly.[Methods]From January 2015 to December 2017,27 elderly patients underwent PELD for lumbar spinal stenosis,and all of them suffered from medical comorbidities and were at high risk of general anesthesia.The visual analogue scale(VAS)for leg pain,Oswestry disability index(ODI),and modified MacNab criteria were used for evaluation of the clinical consequences,additionally the lumbar MRI was taken to evaluate the decompression of nerve roots and stenosis.[Results]All the patients had surgical procedures conducted smoothly under local anesthesia.During operation and the early stage after surgery,no acute onset or deterioration of the medical comorbidities happened,and no new-onset heart,pulmonary or cerebral diseases occurred either in anyone of them.The follow up lasted for 12~39 months.One patient got pain relapsed to preoperative level,which relieved again after the second PELD.The VAS for leg pain significantly decreased from(8.11±0.98)preoperatively to(0.84±0.44)at the latest follow up,while the ODI score significantly declined from(62.82±11.37)%to(10.41±5.70)%correspondingly,which were statistically significant(P<0.05).Based on MacNab criteria,the excellent and good rate of clinical outcomes was of 85.19%at the latest follow up.Regarding to radiographic assessment,obvious decompression of nerve root and canal enlargement were revealed by MRI after operation.[Conclusion]For elderly patients with medical comorbidities and at high risk of general anesthesia,the PELD under local anesthesia does achieve satisfactory clinical outcomes,with advantages of shortened operation time,minimized iatrogenic trauma and improved safety to treat lumbar spinal stenosis.
作者
李冬月
杨晋才
海涌
LI Dong-yue;YANG Jin-cai;HAI Yong(Orthopedic Department,Chaoyang Hospital,Capital Medical University,Beijing100020,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2019年第15期1360-1364,共5页
Orthopedic Journal of China
关键词
腰椎管狭窄症
经皮椎间孔镜减压
内科合并症
老年
lumbar spinal stenosis
percutaneous endoscopic lumbar decompression(PELD)
medical comorbidity
elderly
