CAJ | 학술논문

目的探讨可动式椎间盘镜下单侧开窗双侧减压治疗腰椎管狭窄症的疗效.方法 2007年6月至2009年6月采用可动式椎间盘镜下单侧开窗双侧减压治疗退行性腰椎管狭窄症32例,男14例,女18例;年龄56～74岁,平均65岁.均为双侧椎管狭窄合并椎问盘突出,有间歇性跛行和坐骨神经痛等症状,双下肢症状以一侧为重.在症状严重侧行棘突旁2 cm纵切口,在可动式椎间盘镜下行单侧椎板间隙开窗,神经根通道减压、突出髓核摘除;在棘突和椎板腹侧分别向上、下方用棉片压低保护硬膜囊,潜行咬除棘突基底部,在棘突基底、椎板腹侧与硬膜囊背侧之间形成工作空间,经此空间潜行咬除对侧椎板下缘和增厚的黄韧带,直至显露松解对侧神经根起始部.结果术中无神经损伤发生,无中途转开放手术病例.发生硬膜囊撕裂2例,用棉片将其压低后完成手术.手术时间5～100min,平均70min;术中出血量50～350ml,平均150ml.术后CT示减压充分,中央椎管和对侧椎管扩大,对侧椎板、关节突和椎旁肌等结构保留完好.全部病例随访6～24个月,平均12个月.根据Macnab标准,优21例,良11例.结论可动式椎间盘镜下单侧开窗双侧减压治疗腰椎管狭窄症操作简便,能保留对侧结构,达到双侧减压目的 ,早期随访结果优良.对双侧严重骨性狭窄者应慎用.
목적 탐토가동식추간반경하단측개창쌍측감압치료요추관협착증적료효.방법 2007년6월지2009년6월채용가동식추간반경하단측개창쌍측감압치료퇴행성요추관협착증32례,남14례,녀18례;년령56～74세,평균65세.균위쌍측추관협착합병추문반돌출,유간헐성파행화좌골신경통등증상,쌍하지증상이일측위중.재증상엄중측행극돌방2 cm종절구,재가동식추간반경하행단측추판간극개창,신경근통도감압、돌출수핵적제;재극돌화추판복측분별향상、하방용면편압저보호경막낭,잠행교제극돌기저부,재극돌기저、추판복측여경막낭배측지간형성공작공간,경차공간잠행교제대측추판하연화증후적황인대,직지현로송해대측신경근기시부.결과 술중무신경손상발생,무중도전개방수술병례.발생경막낭시렬2례,용면편장기압저후완성수술.수술시간5～100min,평균70min;술중출혈량50～350ml,평균150ml.술후CT시감압충분,중앙추관화대측추관확대,대측추판、관절돌화추방기등결구보류완호.전부병례수방6～24개월,평균12개월.근거Macnab표준,우21례,량11례.결론 가동식추간반경하단측개창쌍측감압치료요추관협착증조작간편,능보류대측결구,체도쌍측감압목적 ,조기수방결과우량.대쌍측엄중골성협착자응신용.
Objective To evaluate the feasibility and clinical efficacy of bilateral decompression via unilateral fenestration (BDUF) with mobile microendoscopic discectomy (MMED) for canal stenosis of lumbar spine. Methods From June 2007 to June 2009, 32 patients including 14 males and 18 females with an average age of 65 years (rang, 56-74 years) were treated by this technique for canal stenosis of lumbar spine. Patients complained sciatic neuralgia and intermittent claudication which was dominant in one limb. A 2 cm-incision was made beside the spinous process at the side of dominant symptom. The unilateral lamino-tomy as fenestration was performed, followed by discectomy and nerve root decompression. Then the dural theca was protected, and the base of spinous process was removed with Kerrison or high-speed burr, and a working space was made between the dural theca and the contralateral lamina. The contralateral ligament flavum and partial lamina were undercut with Kerrison, until the contralateral nerve root was released. Re-sults The procedure was technically successful in all patients. The mean operative time was 70 minutes (range, 50-100 min), with a mean blood loss of 150 ml (range, 50-350 ml). No significant complication was noted, only dural theca tear was encountered in two patients without obvious side effect. The postoperative CT scan revealed bilateral enlargement of canal with intact contralateral structure. The patients were followed up 12 months (range, 6 to 24 months), and the clinical results were excellent in 21 cases, good in 11 cases according to Macnab scale. Conclusion With MMED technique, BDUF can be performed easily for lumbar canal stenosis with good clinical results; however, severe bilateral osseous stenosis may be not suitable for this technique.