CAJ | 학술논문

目的：研究经皮经椎板间隙入路完全内镜下腰椎侧隐窝减压术的手术策略、安全性及初期临床疗效。方法2012年4月至2013年4月，采用经皮经椎板间隙入路完全内镜下腰椎侧隐窝减压术治疗37例腰椎侧隐窝狭窄症(合并钙化性椎间盘突出或椎体后缘骨赘)。术后第2天及术后3个月复查腰椎MRI评估腰椎侧隐窝减压及椎间盘突出物切除的彻底性。记录术前、术后3、6、12个月的腰痛视觉模拟评分(visualanaloguescales，VAS)、腿痛VAS评分及Oswestry残疾指数(oswestrydisabilityindex，ODI)指数并比较术前及术后各时间点的统计学差异。术后12个月进行MacNab腰椎功能评分。结果手术均顺利完成，手术时间平均50(25～80)min。仅1例术后椎间盘突出复发，采用经皮经椎间孔内窥镜下椎间盘摘除术翻修，1例术后腰痛加重(经封闭证实为腰椎小关节综合征)，无神经损伤、感染及其它手术并发症。腰痛VAS评分：术前(24.4±14.0)分，术后3个月(7.5±6.9)分，术后6个月(5.8±6.0)分，术后12个月(5.6±8.1)分；腿痛VAS评分：术前(76.1±9.9)分，术后3个月(3.6±6.4)分，术后6个月(1.7±3.8)分，术后12个月(1.7±3.8)分；ODI指数：术前(74.7±10.0)，术后3个月(27.7±5.3)，术后6个月(10.1±5.3)，术后12个月(14.4±4.8)。术后各时间点评分较术前均明显降低。术后12个月MacNab评分，20例优，15例良，1例可，1例差。结论根据经皮经椎板间隙入路完全内镜下腰椎侧隐窝减压术是治疗腰椎侧隐窝狭窄症的安全、合理、短期疗效优异的微创脊柱外科手术技术。
목적：연구경피경추판간극입로완전내경하요추측은와감압술적수술책략、안전성급초기림상료효。방법2012년4월지2013년4월，채용경피경추판간극입로완전내경하요추측은와감압술치료37례요추측은와협착증(합병개화성추간반돌출혹추체후연골췌)。술후제2천급술후3개월복사요추MRI평고요추측은와감압급추간반돌출물절제적철저성。기록술전、술후3、6、12개월적요통시각모의평분(visualanaloguescales，VAS)、퇴통VAS평분급Oswestry잔질지수(oswestrydisabilityindex，ODI)지수병비교술전급술후각시간점적통계학차이。술후12개월진행MacNab요추공능평분。결과수술균순리완성，수술시간평균50(25～80)min。부1례술후추간반돌출복발，채용경피경추간공내규경하추간반적제술번수，1례술후요통가중(경봉폐증실위요추소관절종합정)，무신경손상、감염급기타수술병발증。요통VAS평분：술전(24.4±14.0)분，술후3개월(7.5±6.9)분，술후6개월(5.8±6.0)분，술후12개월(5.6±8.1)분；퇴통VAS평분：술전(76.1±9.9)분，술후3개월(3.6±6.4)분，술후6개월(1.7±3.8)분，술후12개월(1.7±3.8)분；ODI지수：술전(74.7±10.0)，술후3개월(27.7±5.3)，술후6개월(10.1±5.3)，술후12개월(14.4±4.8)。술후각시간점평분교술전균명현강저。술후12개월MacNab평분，20례우，15례량，1례가，1례차。결론근거경피경추판간극입로완전내경하요추측은와감압술시치료요추측은와협착증적안전、합리、단기료효우이적미창척주외과수술기술。
Objective To prospectively study the surgical strategy, safety and early clinical outcomes of percutaneous full-endoscopic lumbar lateral recess decompression through interlaminar approach. Methods From April 2012 to April 2013, 37 patients with lumbar lateral recess stenosis with or without calcified disc herniations or osteophytes on the posterior aspect of the vertebral body were treated with percutaneous full-endoscopic lumbar lateral recess decompression through interlaminar approach. The lumbar MRI images were reexamined at 2 days and 3 months after the operation to evaluate decompression of the lateral recess and resection completeness of the prolapsed disc material. The Visual Analogue Scale ( VAS ) scores of low back pain and sciatica and Oswestry Disability Index ( ODI ) scores were recorded preoperatively and at 3, 6 and 12 months after the operation, and the statistically signiifcant differences were compared. The MacNab scores were evaluated at 12 months after the operation. Results All the operations were successfully completed without conversions to other surgical techniques. The average operation time was 50min ( range: 25-80 min ). Only 1 case of reoccurrence was revised with percutaneous transforaminal endoscopic discectomy. One case of facet syndrome was relieved by medial branch block. No nerve injuries, infections or other complications were noticed. The VAS score of low back pain was decreased from ( 24.4±14.0 ) points preoperatively to ( 7.5±6.9 ), ( 5.8±6.0 ) and ( 5.6±8.1 ) points at 3, 6 and 12 months after the operation respectively. The VAS scores of sciatica was decreased from ( 76.1±9.9 ) points preoperatively to ( 3.6±6.4 ), ( 1.7±3.8 ) and ( 1.7±3.8 ) points at 3, 6 and 12 months after the operation respectively. The ODI score was decreased from ( 74.7±10.0 ) points preoperatively to ( 27.7±5.3 ), ( 10.1±5.3 ) and ( 14.4±4.8 ) points at 3, 6 and 12 months after the operation respectively. The postoperative ODI and VAS scores were signiifcantly decreased at each time point when compared with the preoperative scores. According to the MacNab scores at 12 months after the operation, there were 20 excellent cases, 15 good cases, 1 fair case and 1 poor case. Conclusions Percutaneous full-endoscopic lumbar lateral recess decompression through interlaminar approach is a safe and rational minimally invasive spine surgery technique for lumbar lateral recess stenosis, with excellent short-term outcomes.