使用开放式脊柱内窥镜治疗腰椎间盘突出症:技术和临床效果

Medicine Advances Pub Date : 2024-06-27 DOI:10.1002/med4.63
Bing Yu, Jun Zheng
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引用次数: 0

摘要

背景 本文旨在介绍开放式脊柱内镜(OSE),这是一种新型的单孔劈开式脊柱内镜技术,可在保留面关节和后韧带复合体的前提下实现充分减压和腰椎间盘切除术,并确定其是否可广泛开展。 方法 回顾性分析 2021 年 7 月至 2022 年 2 月期间在安徽省第二人民医院使用开放式脊柱内窥镜技术治疗腰椎间盘突出症的 58 例患者的数据。腰部和腿部疼痛采用视觉模拟量表(VAS)评分进行评估,神经状态采用日本骨科协会(JOA)评分进行评估,残疾程度采用奥斯韦特里残疾指数(ODI)进行评估。这些评估在手术前一天和术后最后随访时进行。手术效果采用改良的 MacNab 标准进行评估。Dohzono和Matsumura所描述的方法用于评估面关节的保留情况。 结果 手术后,腿部疼痛的 VAS 评分从 8.4 ± 3.1 降至 0.8 ± 0.8(p < 0.005),背部疼痛的 VAS 评分从 5.4 ± 2.9 降至 1.8 ± 1.5(p < 0.05)。JOA评分从14.7±8.2分提高到23.7±4.8分(p <0.005)。JOA 评分的平均改善率为 74.7% ± 34.7%。ODI从(46.1 ± 5.8)下降到(14.6 ± 7.0)(p < 0.005)。47名患者的最终临床结果为优(81.0%),10名患者为良(17.3%),1名患者为一般(1.7%)。没有患者的最终疗效不佳。手术并发症很少。两名患者在使用内窥镜时硬膜损伤。83.5%±7.4%的病例在入路侧保留了面关节,94.5%±7.3%的病例在对侧保留了面关节。 结论 OSE 是一种单孔分体式内窥镜技术。与其他微创脊柱内窥镜技术相比,其学习曲线没有那么陡峭,更容易掌握。开放式脊柱内窥镜可在保留面关节和后韧带复合体的情况下实现充分减压和腰椎间盘切除术,可广泛开展。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Treatment of lumbar intervertebral disc herniation using open spinal endoscopy: Techniques and clinical outcomes

Treatment of lumbar intervertebral disc herniation using open spinal endoscopy: Techniques and clinical outcomes

Background

The aims of this paper are to introduce Open spinal endoscopy (OSE), which is a new single hole split-type spinal endoscopic technique that can achieve adequate decompression and lumbar discectomy with preservation of the facet joints and posterior ligamentous complex, and to determine whether it can be widely performed.

Methods

Data from 58 patients who were treated for lumbar disc herniation using the open spinal endoscopic technique at Anhui No. 2 Provincial People's Hospital between July, 2021 and February, 2022 were retrospectively analyzed. Pain in the lower back and legs was evaluated using the visual analog scale (VAS) score, neurologic status by the Japanese Orthopedic Association (JOA) score, and degree of disability by the Oswestry Disability Index (ODI). These evaluations were performed on the day before surgery and at the final postoperative follow-up. Surgical outcomes were assessed using the modified MacNab criteria. The method described by Dohzono and Matsumura was used to evaluate facet joint preservation.

Results

After surgery, the VAS score decreased from 8.4 ± 3.1 to 0.8 ± 0.8 (p < 0.005) for leg pain and from 5.4 ± 2.9 to 1.8 ± 1.5 (p < 0.05) for back pain. The JOA score improved from 14.7 ± 8.2 to 23.7 ± 4.8 (p < 0.005). The average rate of improvement in the JOA score was 74.7% ± 34.7%. The ODI decreased from 46.1 ± 5.8 to 14.6 ± 7.0 (p < 0.005). The final clinical outcome was excellent in 47 patients (81.0%), good in 10 (17.3%), and fair in one (1.7%). No patient had a poor final outcome. There were few operative complications. Dural injury occurred during use of the endoscope in two patients. The facet joint was preserved in 83.5% ± 7.4% of cases on the approach side and in 94.5% ± 7.3% on the contralateral side.

Conclusions

OSE is a single hole split-type endoscopic technology. Compared with that for other minimally invasive spinal endoscopic techniques, the learning curve is less steep and easier to master. Open spinal endoscopy can achieve adequate decompression and lumbar discectomy with preservation of the facet joints and posterior ligamentous complex and can be performed widely.

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