椎间孔镜下改良环锯技术部分切除增生上关节突治疗腰神经根卡压综合征的效果

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摘要目的评估椎间孔镜下改良环锯技术部分切除增生上关节突(superior articular process,SAP),治疗SAP增生引起的腰神经卡压综合征(lumbar nerve root entrapment syndrome,LNRES)的效果。方法选择2015-04至2019-07医院收治的LNRES患者10 例,10个椎间孔,均为L_4/5单侧(左4右6)。均拟接受经皮改良环锯技术将增生的SAP切除椎间孔扩大成形术,椎间孔镜下清理、松解神经根。术前、术后1周、12周及末次随访时患者行功能查体,X线、CT检查,分别进行VAS疼痛分级法判定,疗效评定采用JOA腰背痛手术评分标准和 MacNab 腰腿痛手术标准。结果术后影像学检查椎间孔减压成形良好,VAS 评分:治疗后1周、12周,末次随访3组较术前明显降低(P<0.05),末次随访组较术后1周降低(P<0.05),术后1周组和12周组,12周组和末次随访组差异均无统计学意义。JOA 评分:治疗后1周、12周,末次随访3组较术前明显降低(P<0.05),和术后1周比,术后12周组、末次随访组均降低(P<0.05),术后12周组和末次随访组差异无统计学意义。MacNab标准:术后1周,有效10例;术后12周有效2例,显效8例;末次随访显效10例。结论改良环锯技术联合椎间孔镜整块切除部分增生SAP治疗LNRES是一种微创、简洁、有效、价格低廉的方法。

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	白春宏
	孙明林
	金晋浙
	王锋

关键词 ：内镜, 部分切除, SAP增生, 腰神经卡压综合征

Abstract：Objective To analyze the therapeutic effect of partial excision of hyperplastic SAP by modified trephine under the transforaminal approach,and of endoscopic debridement and decompression of nerve roots in the treatment of lumbar nerve root entrapment syndrome (LNRES) caused by the hyperplastic superior articular process.Methods Ten LNRES patients with 10 intervertebral foramina were selected between April 2015 and July 2019,all of whom were L_4/5 unilateral (left 4 right 6).They were scheduled to undergo the modified percutaneous trephine for partial resection of the hyperplastic upper articular process and debridement of intervertebral foramina.Preoperatively,1 week and 12 weeks postoperatively and during the last follow-up,these patients underwent functional examination,X-ray and CT examination,respectively.The VAS pain grading method,JOA low back pain scores and MacNab criteria were adopted.Results The postoperative imaging examination showed that the intervertebral foramina were well decompressed.The VAS scores 1 week and 12 weeks after surgery and during the last follow-up became significantly lower (P<0.05),especially during the last follow-up(P<0.05),but there was no significant difference between the three groups.JOA scores 1 week and 12 weeks postoperatively and during the last follow-up also became significantly lower(P<0.05),especially during the 12-week group and the last follow-up group (P<0.05),but there was no significant difference between these two groups.In terms of MacNab criteria,10 cases were good in the 1-week group,2 cases were good and 8 cases were excellent in the 12-week group,and 10 cases were excellent in the last follow-up group.Conclusions The modified trephine combined with endoscopic discectomy is a minimally invasive,simple,effective and inexpensive approach to LNRES.

Key words： endoscopic partial resection hyperplastic superior articular process lumbar nerve root entrapment syndrome

收稿日期: 2020-08-20

ZTFLH:

R681.53

作者简介: 白春宏,博士后,副主任医师。

引用本文:

白春宏, 孙明林, 金晋浙, 王锋. 椎间孔镜下改良环锯技术部分切除增生上关节突治疗腰神经根卡压综合征的效果[J]. 武警医学, 2021, 32(1): 1-5. BAI Chunhong, SUN Minglin, JIN Jinzhe, WANG Feng. Lumbar nerve root entrapment syndrome treated with modified trephine and endoscopic partial resection of hyperplastic superior articular process. Med. J. Chin. Peop. Armed Poli. Forc., 2021, 32(1): 1-5.

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http://journal08.magtechjournal.com/Jwk_wjyx/CN/ 或 http://journal08.magtechjournal.com/Jwk_wjyx/CN/Y2021/V32/I1/1

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