[1]付松,吕仁花,邵诗泽,等. 经皮椎间孔入路内镜下治疗老年腰椎融合术后邻椎病[J].中华老年骨科与康复电子杂志,2019,(04):217-222.[doi:DOI：10.3877/cma.j.issn.2096-0263.2019.04.007]
　Fu Song,Lyu Renhua,Shao Shize,et al. Percutaneus endoscopic transforaminal approach decompression accurately for adjacent segmental disease after lumbar fusion[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2019,(04):217-222.[doi:DOI：10.3877/cma.j.issn.2096-0263.2019.04.007]
点击复制

 经皮椎间孔入路内镜下治疗老年腰椎融合术后邻椎病()
分享到：

中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2019年04期
页码:
217-222
栏目:
论著
出版日期:
2019-08-05

文章信息/Info

Title:
 Percutaneus endoscopic transforaminal approach decompression accurately for adjacent segmental disease after lumbar fusion
作者:
付松1 ; 吕仁花2 ; 邵诗泽1 ; 侯海涛1 ; 王龙强1 ; 王亚楠1 ; 刘海军1 ; 邹奇1 ; 王欢1 ; 黄相鹏1;  张翔1 ; 王振宇1 ; 宋钦鹏1
作者单位：264400 威海，山东省文登整骨医院脊柱脊髓科1；264400 威海，山东省威海市文登中心医院神经内科2
Author(s):
 Fu Song;  Lyu Renhua;  Shao Shize;  Hou Haitao;  Wang Longqiang;  Wang Yanan;  Liu Haijun;  Zou Qi;  Wang Huan;  Huang Xiangpeng;  Zhang Xiang;  Wang Zhenyu;  Song Qinpeng.
 1Department of Spinal Cord, Shandong Wendeng Orthopeadic Hospital, Weihai 264400, China; 2Department of Neurology, the Affiliated Weihai Central Hospital, Weihai 264400, China
关键词:
 ; 【关键词】 腰椎;  老年人;  内镜;  微创手术
Keywords:
 ; 【Key words】 Lumbar vertebrae;  Aged;  Endoscopy;  Minimally invasive surgical procedures
DOI:
DOI：10.3877/cma.j.issn.2096-0263.2019.04.007
文献标志码:
A
摘要:
 【摘要】 目的 讨论经皮椎间孔入路内镜下治疗老年腰椎融合术后邻椎病的临床疗效。方法 回顾性收集2015年1月至2016年8月山东省文登整骨医院脊柱脊髓科收治的老年腰椎融合术后出现邻椎病的患者34例，男性25例，女性9例，年龄61～81岁，平均年龄（66±7）岁。全部患者采用经皮椎间孔入路内镜减压手术。记录手术时间及术中应注意的事项。在术前、术后1、6、12个月及末次随访时，按MacNab标准进行临床疗效的评价，进行腰部及下肢的疼痛视觉模拟评分（VAS）及Oswestry功能障碍指数（ODI）；在6个月随访时，行腰椎MRI检查评估神经根减压状况，并进行腰椎正侧位、动力位片评价本次手术节段的稳定性。结果 34例患者均顺利完成手术，随访时间为24～44个月，平均（32±7）个月。手术时间54～142 min，平均（68±30）min。重复测量的方差分析显示，术后1、6、12个月、末次随访时，ODI较术前明显下降，差异具有统计学意义（F=2008.780，P＜0.001）；腰痛VAS评分较术前明显下降，差异具有统计学意义（F=599.821，P＜0.001）；下肢痛VAS评分较术前明显下降，差异具有统计学意义（F=601.751，P＜0.001）；6个月随访时，改良MacNab 标准评估：优27例、良5例、可2例，优良率为94.12%。1例出现置管过程中导丝断裂；1例出现出口神经根外膜的撕裂；1例患者出现出口根刺激症状。末次随访时，3例椎间失稳。未发生神经根及硬膜囊的损伤，未发生手术节段错误。结论 经皮椎间孔入路内镜治疗老年人腰椎融合术后邻椎病，创伤小，临床疗效好。
Abstract:

【Abstract】 Objective To discuss the effect of treatment and the matters needing attention during the operation Through percutaneous transforaminal endoscopic surgery for Adjacent segmental disease after lumbar fusion. Methods From January 2015 to August 2016, 34 elderly patients (25 males and 9 females) with adjacent vertebral diseases occurred after lumbar fusion. The age ranged from 61 to 81 years, with an average of (66±7) years. All patients underwent percutaneous endoscopic decompression via transforaminal approach. Record the time of operation and the matters needing attention during the operation. In the preoperative and postoperative 1, 6, 12 months and the last follow-up, the clinical efficacy was evaluated according to the MacNab standard, the visual analogue score of the pain of the waist and lower limbs (VAS) and the Oswestry dysfunction index (ODI) were performed. During the follow-up of 6 months, lumbar MRI was performed to evaluate the status of nerve root decompression, and the stability of the operation was evaluated by anteroposterior and lateral lumbar radiographs and dynamic radiographs. Results The operation time was successfully completed in all 34 patients. The time of operation was 54-142 min, with an average of (68±30) min. The follow-up time was 24-44 months, with an average of (32±7) months. The scores of ODI at 1, 6, 12 months and final follow-up were significantly lower than those before operation (F=2008.780, P<0.001)；The scores of Low back pain VAS at 1, 6, 12 months and final follow-up were significantly lower than those before operation (F=599.821, P<0.001)；The scores of Lower limb pain VAS at 1, 6,12 months and final follow-up were significantly lower than those before operation (F=601.751, P<0.001). At the time of follow up in June, the modified MacNab criteria assessed excellent outcomes in 27 cases, good in 5 cases, and fair in 2 cases, with an excellent and good rate of 94.12%.One case had rupture of the guide wire, one case had tear of the epineurium of the outlet nerve root, and one case had irritation of the outlet root. At the last follow-up, 3 cases of intervertebral instability were found. No nerve root and dural sac injury occurred, no operative segment errors occurred. Conclusion Percutaneous intervertebral foramen endoscopic treatment of adjacent vertebral disease in elderly patients after lumbar fusion has less trauma and good clinical effect.

参考文献/References:

 

1 Zeng ZY, Wu P, Sun DT, et al. Two different fixation methods combined with lumbar interbody fusion for the treatment oftwo-level lumbar vertebra diseases:a clinical comparisonstudy [J]. Zhongguo Gu Shang, 2015, 28(10): 903-909.
2 Harrop JS, YoussefJA, Maltenfort M, et al. Lumbar adjacent segmentdegeneration and disease after arthrodesis and total disc arthroplasty [J]. Spine ( Phila Pa 1976) , 2008, 33(15): 1701-1707.
3 Li G, Patil CG, Lad SP, et al. Effects of age and comorbidities on complication rates and adverse outcomes after lumbar laminectomy in elderly patients [J]. Spine (Phila Pa 1976), 2008, 33(11): 1250-1255.
4 Komp M, Hahn P, Oezdemir S, et al. Bilateral spinal decompression of lumbar central stenosis with the full-endoscopic interlaminar versus microsurgical laminotomy technique: a prospective, randomized, controlled study [J]. Pain Physician, 2015, 18(1): 61-70.
5 Djurasovic M, Glassman SD, Carreon LY, et al. Contemporary management of symptomatic lumbar spinal stenosis [J]. Orthop Clin North Am, 2010, 41(2): 183-191.
6 Iguchi T, Kanemura A, Kasahara K, et al. Lumbar instability and clinical symptoms: which is the more critical factor for symptoms: sagittal translation or segment angulation? [J]. J Spinal Disord Tech, 2004, 17(4): 284-290.
7 Lee SE, Jahng TA, Kim HJ. Facet joint changes after application of lumbar nonfusion dynamic stabilization [J]. Neurosurg Focus, 2016, 40(1): E6.
8 Kobayashi S. Pathophysiology, diagnosis and treatment of intermittent claudication in patients with lumbar canal stenosis[J].World J Orthop, 2014,5(2):134-145.
9 钱宇, 徐国健, 金聪, 等. 腰椎管狭窄症致压因素与减压方式关系的研究[J]. 中华骨科杂志, 2016, 36(22): 1417-1425.
10 Jacobs WC, Rubinstein SM, Willems PC, et al. The evidence onsurgical interventions for low back disorders,an overview of systematic reviews [J]. Eur Spine J, 2013, 22(9): 1936-1949.
11 Chang F, Zhang T, Gao G, et al. Comparison of the minimally invasive and conventional open surgery approach in the treatment of lumbar stenosis: a systematic review and a Meta-Analysis [J]. Ann Acad Med Singapore, 2017, 46(4): 124-137.
12 Schubert M, Hoogland T. Endoscopic transforaminal nucleotomy with foraminoplasty for lumbar disk herniation [J]. Oper Orthop Traumatol, 2005, 17(6): 641-661.
13 Kim HS, Patel R, Paudel B, et al. Early Outcomes of EndoscopicContralateral Foraminal and Lateral Recess Decompression viaan Interlaminar Approach in Patients with Unilateral Radiculopathy from Unilateral Foraminal Stenosis[J]. World Neurosurg,2017, 108: 763-773.
14 Sairyo K, Matsuura T, Higashino K, et al. Surgery related complications in percutaneous endoscopic lumbar discectomy under local anesthesia [J]. J Med Invest, 2014, 61(3/4): 264-269.
15 Jacquot F, Gastambide D. Percutaneous endoscopic transforaminal lumbar interbody fusion: is it worth it? [J]. Int Orthop, 2013, 37(8): 1507-1510.
16 Kambin P, Casey K, O’brien E, et al. Transforaminal arthroscopic decompression of lateral recess stenosis [J]. J Neurosurg, 1996, 84(3): 462-467.



相似文献/References:

[1]鲍飞龙 刘涛 亢世杰 黄东生 江涛 胡义明. 双反牵引装置治疗Schatzker分型Ⅴ、Ⅵ型胫骨平台骨折的优势[J].中华老年骨科与康复电子杂志,2018,(05):266.
　Bao Feilong,Liu Tao,Kang Shijie,et al.The advantage of homeopathic double reverse traction device treating tibial plateau fractures of typing Schatzker Ⅴ and Ⅵ[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2018,(04):266.
[2]王哲培 张凯 保罗 汪毅 白震民. 太极拳对老年女性下肢静态平衡、本体感觉与功能活动的影响[J].中华老年骨科与康复电子杂志,2018,(05):296.
　Wang Zhepei,Zhang Kai,Pablo,et al. The influence of Taijiquan on the lower limbs static balance, proprioception and functional activities of older women[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2018,(04):296.
[3]刘磊 王宝泉 孙然 杨宗酉 孙家元 陈伟 王海立 殷兵 刘松 李石伦 杨光 张英泽. 2010年至2011年中国东部和西部地区成人股骨转子间骨折流行病学对比分析[J].中华老年骨科与康复电子杂志,2018,(05):302.
　Liu Lei,Wang Baoquan,Sun Ran,et al.Epidemiological comparison of adult femoral intertrochanteric fractures between the east and west areas in China from 2010 through 2011[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2018,(04):302.
[4]吴石磊 刘勇 邵增务 田青. 骨组织细胞外泌体对骨代谢作用的研究现状[J].中华老年骨科与康复电子杂志,2018,(05):308.
　Wu Shilei,Liu Yong,Shao Zengwu,et al. Research status of bone tissue-derived exosomes on bone metabolism[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2018,(04):308.
[5]张世峰 金群华. 胫骨高位截骨术治疗膝内侧单间室骨关节炎的研究进展[J].中华老年骨科与康复电子杂志,2018,(05):312.
　Zhang Shifeng,Jin Qunhua.. Research progress of high tibial osteotomy in the treatment of medial single compartment osteoarthritis[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2018,(04):312.
[6]赵永辉,陆声,马宇龙,等. 皮质骨通道螺钉技术在腰椎退变性疾病中的临床应用[J].中华老年骨科与康复电子杂志,2019,(03):123.[doi:10.3877/cma.j.issn.2096-0263.2019.001]
　Zhao Yonghui,Lu Sheng,Ma Yulong,et al. Clinical application of cortical bone screw technique in elderly patients with lumbar degenerative diseases[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2019,(04):123.[doi:10.3877/cma.j.issn.2096-0263.2019.001]
[7]王虎 李明 靳泽岳 连晓东 陈伟. 不同方法治疗老年股骨转子间合并转子下骨折的比较[J].中华老年骨科与康复电子杂志,2019,(03):135.[doi:DOI：10.3877/cma.j.issn.2096-0263.2019.003]
　Wang Hu,Chen Wei.. Comparative of different methods for the treatment of intertrochanteric-subtrochanteric fracture[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2019,(04):135.[doi:DOI：10.3877/cma.j.issn.2096-0263.2019.003]
[8]明立功 孟维娜 明朝戈 栗贡策 王自方 王新德 明立山 许振华.腓骨近端截骨联合中医药治疗膝关节内侧间室骨关节炎肝肾不足、气滞血瘀证[J].中华老年骨科与康复电子杂志,2019,(03):149.[doi:DOI：10.3877/cma.j.issn.2096-0263.2019.005]
　Ming Ligong,Meng Weina,Ming Chaoge,et al. Proximal fibular osteotomy combined with traditional Chinese medicine in the treatment of osteoarthritis of medial compartment of knee joint with liver and kidney insufficiency, qi stagnation and blood stasis syndrome[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2019,(04):149.[doi:DOI：10.3877/cma.j.issn.2096-0263.2019.005]
[9]胡建平 李俊峰 秦鸿雁 张强 张卫国 陈明. 长短髓内钉治疗老年股骨反转子间骨折的疗效比较[J].中华老年骨科与康复电子杂志,2019,(03):143.[doi:DOI：10.3877/cma.j.issn.2096-0263.2019.004]
　Hu Jianping,Li Junfeng,Qin Hongyan,et al. Comparison of short intramedullary nail and long intramedullary nail for the treatment of reverse oblique intertrochanteric fractures in the elderly[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2019,(04):143.[doi:DOI：10.3877/cma.j.issn.2096-0263.2019.004]
[10]魏宁 常文利 杜晨光 侯志勇 张世强 焦振清 李增炎 陈伟 张英泽. 河北医科大学第三医院956例后踝骨折的流行病学分析[J].中华老年骨科与康复电子杂志,2019,(03):167.[doi:DOI：10.3877/cma.j.issn.2096-0263.2019.008]
　Wei Ning,Chang Wenli,Du Chenguang,et al. The retrospective analysis of 956 cases with posterior malleolar fractures[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2019,(04):167.[doi:DOI：10.3877/cma.j.issn.2096-0263.2019.008]

备注/Memo

备注/Memo:

基金项目：威海市科技发展计划项目（2011-2-94-2）
更新日期/Last Update: 2019-09-19