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单边双通道内镜技术治疗腰椎术后邻近节段病变的早期疗效观察
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作者Author单位UnitE-Mail
周建伟 ZHOU Jian-wei 首都医科大学附属北京同仁医院骨科脊柱外科专业组, 北京 100730 Department of Orthopaedic Spine Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China trdrzhou@163.com 
李矛 LI Mao 首都医科大学附属北京同仁医院骨科脊柱外科专业组, 北京 100730 Department of Orthopaedic Spine Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China  
迟成 CHI Cheng 首都医科大学附属北京同仁医院骨科脊柱外科专业组, 北京 100730 Department of Orthopaedic Spine Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China  
王飞 WANG Fei 首都医科大学附属北京同仁医院骨科脊柱外科专业组, 北京 100730 Department of Orthopaedic Spine Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China  
闫辉 YAN Hui 首都医科大学附属北京同仁医院骨科脊柱外科专业组, 北京 100730 Department of Orthopaedic Spine Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China  
唐家广 TANG Jia-guang 首都医科大学附属北京同仁医院骨科脊柱外科专业组, 北京 100730 Department of Orthopaedic Spine Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China  
期刊信息:《中国骨伤》2023年36卷,第5期,第480-486页
DOI:10.12200/j.issn.1003-0034.2023.05.016


目的:探讨单边双通道内镜技术治疗腰椎术后邻近节段病变的早期临床疗效。

方法: 2019年6月至2020年6月采用单边双通道内镜技术治疗腰椎术后邻近节段病变患者14例,其中男9例,女5例,年龄52~73岁,2次手术间隔时间19~64个月。腰椎融合术后邻近节段退变患者10例,腰椎非融合固定术后4例;均采用单边双通道内镜辅助下后路单侧椎板开窗椎管减压术或者经单侧入路潜行减压至对侧。观察手术时间、术后住院时间及并发症情况,记录术前、术后3 d及术后3、6个月随访时腰痛和腿痛的疼痛视觉模拟评分(visual analogue scale,VAS),Oswestry功能障碍指数(Oswestry disability index,ODI),以及改良的日本矫形外科学会腰椎功能(modified Japanese Orthopedic Association,mJOA)评分。

结果:所有手术顺利完成。手术时间32~151 min。术后CT示减压充分,大部分关节突关节得以保留。术后1~3 d下床行走,术后住院时间为1~8 d。术后随访时间为6~11个月。14例患者术后3周内均恢复正常生活,术后3 d及3、6个月患者的腰腿痛VAS、ODI、mJOA评分均明显改善。1例术后出现脑脊液漏,给予局部加压缝合切口,保守治疗后伤口愈合;1例术后出现马尾神经损伤表现,康复治疗后于1个月左右逐步恢复;1例术后出现下肢一过性疼痛加重,给予激素、脱水药物和对症处理,症状减轻,于术后7 d症状缓解。

结论:单边双通道内镜技术用于治疗腰椎术后邻近节段病变的早期临床效果优良,为邻近节段病变的治疗提供了新的微创、非固定的选择。
[关键词]:腰椎  邻近节段病变  外科手术  内窥镜  手术后并发症
 
Observation of early clinical efficacy of unilateral biportal endoscopy technique in the treatment of lumbar postoperative adjacent segmental diseases
Abstract:

Objective To investigate early clinical efficacy of unilateral biportal endoscopy technique for the treatment of lumbar postoperative adjacent segmental diseases.

Methods Fourteen patients with lumbar postoperative adjacent segmental diseases were treated with unilateral biportal endoscopy technique from June 2019 to June 2020. Among them,there were 9 males and 5 females,aged from 52 to 73 years old,and the interval between primary and revision operations ranged from 19 to 64 months. Adjacent segmental degeneration occurred after lumbar fusion in 10 patients and after lumbar nonfusion fixation in 4 patients. All the patients received unilateral biportal endoscopy assisted posterior unilateral lamina decompression or unilateral approach to the contralateral decompression. The operation time,postoperative hospital stay and complications were observed. The visual analogue scale (VAS) of low back pain and leg pain,Oswestry Disability Index (ODI),modified Japanese Orthopaedic Association (mJOA) score were recorded before operation and at 3 days,3 months,and 6 months after operation.

Results All procedures were successfully completed. Surgical duration ranged from 32 to 151 min. Postoperative CT showed adequate decompression and preservation of most joints. Out of bed walking 1 to 3 days after surgery,postoperative hospital stay was 1 to 8 days,and postoperative follow-up was 6 to 11 months. All 14 patients returned to normal life within 3 weeks after surgery,and VAS,ODI,and mJOA scores improved significantly at 3 days and 3,6 months after surgery. One patient occurred cerebrospinal fluid leak after operation,received local compression suture,and the wound healed after conservative treatment. One patient occurred postoperative cauda equina neurologic deficit,which was gradually recovered about 1 month after rehabilitation therapy. One patients advented transient pain of lower limbs after surgery,and the symptoms were relieved after 7 days of treatment with hormones,dehydration drugs and symptomatic management.

Conclusion Unilateral biportal endoscopy technique has a good early clinical efficacy in the treatment of lumbar postoperative adjacent segmental diseases,which may provide a new minimally invasive,non-fixation option for the treatment of adjacent segment disease.
KEYWORDS:Lumbar vertebrae  Adjacent segmental diseases  Surgical procedures  endoscopic  Postoperative complication
 
引用本文,请按以下格式著录参考文献:
中文格式:周建伟,李矛,迟成,王飞,闫辉,唐家广.单边双通道内镜技术治疗腰椎术后邻近节段病变的早期疗效观察[J].中国骨伤,2023,36(5):480~486
英文格式:ZHOU Jian-wei,LI Mao,CHI Cheng,WANG Fei,YAN Hui,TANG Jia-guang.Observation of early clinical efficacy of unilateral biportal endoscopy technique in the treatment of lumbar postoperative adjacent segmental diseases[J].zhongguo gu shang / China J Orthop Trauma ,2023,36(5):480~486
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