局部麻醉下清醒状态下单侧双侧内窥镜减压术治疗老年人退行性腰椎管狭窄症：可行性研究与技术说明

IF 3.6 3区医学

Clinical Interventions in Aging Pub Date : 2024-01-06 DOI:10.2147/cia.s443792

Tong Wu, Da Liu, Fanhe Meng, Jing-han Lu, Yi-feng Chen, Zheng Fan

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引用次数: 0

摘要

目的：在此，我们介绍了一种新型的清醒单侧双侧内窥镜（UBE）减压策略，该策略采用清醒镇静结合分步局部麻醉（LA）的方法替代全身麻醉（GA）。该研究旨在评估清醒状态下 UBE 减压治疗老年退行性腰椎管狭窄症（DLSS）的可行性：这项回顾性研究纳入了 2021 年 1 月至 2022 年 3 月期间在我院接受清醒 UBE 减压术治疗 DLSS 的 31 例连续患者。临床结果采用患者报告结果指标（PROM）进行评估，包括腿部疼痛视觉模拟量表（VAS-LP）、Oswestry残疾指数（ODI）和改良MacNab标准。麻醉效果和术中体验通过术中 VAS 和满意度评分系统进行评估：结果：所有患者均在 LA 联合意识镇静下成功实施了尿囊减压术。26名患者（83.9%）将术中体验评为满意（优或良），5名患者（16.1%）评为一般。术中 VAS 平均值为 3.41±1.26。术后各随访阶段的 VAS 和 ODI 与术前相比均有明显改善（P < 0.01）。在最后一次随访中，28 名患者（90.3%）认为手术效果良好或优秀，3 名患者（9.7%）认为手术效果一般。研究中未发现严重并发症或不良反应：我们的初步研究结果表明，对于患有腰椎退行性疾病的老年患者来说，清醒状态下的 UBE 减压术是一种可行且前景广阔的选择。关键词：清醒脊柱手术；局部麻醉；腰椎退行性疾病；双侧内窥镜脊柱手术；术后恢复能力增强

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Awake Unilateral Biportal Endoscopic Decompression Under Local Anesthesia for Degenerative Lumbar Spinal Stenosis in the Elderly: A Feasibility Study with Technique Note

Purpose: Here, we introduce a novel strategy of awake unilateral biportal endoscopic (UBE) decompression, which applies conscious sedation combined with stepwise local anesthesia (LA) as an alternative to general anesthesia (GA). The study aims to evaluate the feasibility of awake UBE decompression for degenerative lumbar spinal stenosis (DLSS) in elderly patients.
Patients and Methods: This retrospective study included 31 consecutive patients who received awake UBE decompression for DLSS in our institution from January 2021 to March 2022. Clinical results were evaluated using patient-reported outcomes measures (PROM) including visual analog scale for leg pain (VAS-LP), Oswestry Disability Index (ODI), and modified MacNab criteria. The anesthesia effectiveness and intraoperative experience were evaluated by intraoperative VAS and satisfaction rating system.
Results: UBE decompression was successfully performed in all patients under LA combined with conscious sedation. 26 (83.9%) patients rated the intraoperative experience as satisfactory (excellent or good) and 5 (16.1%) as fair. The mean intraoperative VAS was 3.41± 1.26. The VAS and ODI at each follow-up stage after surgery were significantly improved compared to preoperative scores (p < 0.01). At the last follow-up, 28 patients (90.3%) classified the surgical outcome as good or excellent, and 3 (9.7%) as fair. There were no serious complications or adverse reactions observed in the study.
Conclusion: Our preliminary results suggest that awake UBE decompression is a feasible and promising alternative for elderly patients with DLSS.

Keywords: awake spinal surgery, local anesthesia, degenerative lumbar disease, biportal endoscopic spine surgery, enhanced recovery after surgery

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来源期刊

Clinical Interventions in Aging GERIATRICS & GERONTOLOGY-

CiteScore

6.20

自引率

2.80%

发文量

193

期刊介绍： Clinical Interventions in Aging, is an online, peer reviewed, open access journal focusing on concise rapid reporting of original research and reviews in aging. Special attention will be given to papers reporting on actual or potential clinical applications leading to improved prevention or treatment of disease or a greater understanding of pathological processes that result from maladaptive changes in the body associated with aging. This journal is directed at a wide array of scientists, engineers, pharmacists, pharmacologists and clinical specialists wishing to maintain an up to date knowledge of this exciting and emerging field.