【摘要】 目的 探讨采用脊柱内镜可视环锯技术治疗高龄退变性腰椎侧凸椎间孔狭窄的临床疗效。方法 回顾性分析2020年3月至2021年5月46例行脊柱内镜可视环锯技术治疗高龄退变性腰椎侧凸椎间孔狭窄患者的资料，男25例，女21例；年龄72～85岁，平均（77.5±2.6）岁。责任节段L_4～5 35例、L₅S₁ 11例。使用脊柱内镜Endo-surgy standard手术器械套装可视镜外环锯行椎间孔扩大再造成形，使用髓核钳咬除椎间孔背侧增生肥厚的黄韧带及孔内增生韧带。对伴随腰椎间盘明显突出者，术中摘除突出髓核，使狭窄的椎间孔充分扩大成形。记录手术出血量、手术时间、住院时间及术后并发症等基本信息。完善术后腰椎过伸过屈侧位X线评估腰椎稳定性，腰椎正位X线片评估腰椎侧凸变化，腰椎CT观察椎间孔减压程度。按照视觉模拟评分（visual analogue scale, VAS）评价术前及术后1个月、6个月及12个月的疼痛程度。按照Oswestry功能障碍指数（Oswestry disability index, ODI）评价术前及术后1个月、6个月及12个月腰椎功能障碍严重程度。术后1年按照腰椎MacNab功能标准评价手术疗效。结果 所有手术均顺利完成，无血管及神经损伤等并发症，术中出血量（22.38±4.64） mL,手术时间（52.95±4.98） min,术后住院时间（3.00±0.45） d。所有患者术后复查腰椎CT显示椎间孔区减压充分；术后复查腰椎过伸过屈侧位X线片显示腰椎稳定性良好；术后复查腰椎正位X线片显示侧凸较术前无进展。46例随访12～24个月，平均（18.32±2.55）个月。按MacNab标准，优39例，良3例，可4例，优良率91.30%。术后1、6、12个月VAS和ODI评分均较术前明显改善（P<0.001）。结论 采用脊柱内镜可视环锯技术治疗高龄退变性腰椎侧凸椎间孔狭窄近期疗效满意，是一种安全、有效的微创手术方式。更多还原

【Abstract】 Objective To investigate the clinical effect of endoscopic visual trephine in the treatment of senile foraminal stenosis with degenerative lumbar scoliosis.Methods The dataof 46elderly patients of foraminal stenosis with degenerative lumbar scoliosis treated by endoscopic visual ring saw from March 2020to May 2021 were retrospectively analyzed.There were 25males and 21females,aged 72～85years,with an average age of（77.5±2.6）years.There were 35cases of responsible segment L_4～5and 11cases of L₅S₁.Endoscopic Endo-surgy standard surgical instrument set was used to enlarge and reconstruct the foraminal foramina,and the hypertrophic yellow ligament on the dorsal side of the foraminaand the intraforaminal hypertrophic ligament were removed using anucleus pulposus forceps.For patients with significant lumbar disc herniation,the protruded nucleus pulposus was removed intraoperatively to fully enlarge the narrow foramina.Surgical blood loss,operation time,hospital stay and postoperative complications were recorded.Postoperative lumbar hyperextension and flexion lateral X-ray was improved to evaluate the stability of the lumbar spine,lumbar anteroposterior X-ray to evaluate the changes of lumbar scoliosis,and lumbar CT to observe the degree of foraminal decompression.visual analogue scale（VAS）was used to evaluate the degree of pain before surgery and 1,6and 12months after surgery.The severity of lumbar dysfunction was evaluated according to the Oswestry disability index（ODI）before surgery and at 1,6and 12months after surgery.One year after surgery,the efficacy was evaluated according to the functional criteria of lumbar MacNab.Results All the operations were successful without any complications such as vascular and nerve injury.The intraoperative blood loss was（22.38±4.64）mL,the operative time was（52.95±4.98）min,and the postoperative hospital stay was（3.00±0.45）d.Postoperative lumbar CT examination in all patients showed sufficient decompression in the foraminal area.Postoperative review of lumbar hyperextension and flexion lateral radiographs showed good lumbar stability.Postoperatively,lumbar anteroposterior radiographs showed no progress in scoliosis.46cases were followed up for 12～24 months,with an average of（18.32±2.55）months.According to MacNab standard,39cases were excellent,3cases were good,and 4cases were fair,with an excellent and good rate of 91.30%.VAS and ODI scores at 1,6and 12 months after surgery were significantly improved compared with those before surgery （P<0.001）.Conclusion Endoscopic visual ring saw technique is a safe and effective minimally invasive method for treating senile foraminal stenosis with degenerative lumbar scoliosis.更多还原