SEESSYS导航辅助椎间孔镜治疗腰椎侧方椎管狭窄症的早期临床疗效*

EARLY CLINICAL EFFICACY OF SEESSYS ASSISTED PERCUTANEOUS ENDOSCOPIC TRANSFORAMINAL DECOMPRESSION FOR LATERAL LUMBAR SPINAL CANAL STENOSIS

摘要:

目的：描述SEESSYS导航辅助椎间孔镜治疗腰椎侧方椎管狭窄症的手术方法和早期临床疗效。方法：2018年12月至2019年9月,43例单节段的腰椎侧方椎管狭窄症患者纳入研究。采用SEESSYS导航技术进行内镜下减压的患者18例(导航组),男7例,女11例,年龄35-80岁,平均(58.22±13.59)岁。采用C臂透视定位内镜下减压的患者25例(传统组),男12例,女13例,年龄35-85岁,平均(56.16±13.30)岁。记录两组患者的手术时间,术中透视次数,术前、术后3月、术后6月的疼痛视觉模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数(oswestry disability index,ODI),采用改良Macnab标准在末次随访时评价临床疗效。结果：43例患者均获得至少6个月随访。导航组平均手术时间(68.56±24.53)min,传统组为(86.44±30.46)min(t= -2.055, P= 0.046)；导航组术中平均透视次数(6.17±2.45)次,传统组(17.12±9.33)次(t=-5.607, P <0.001)；两组间比较差异具有统计学意义。末次随访时导航组腰痛VAS评分平均(1.78±0.94)分,传统组为(2.00±1.19)分(t=-0.657,P=0.515)；导航组腿痛VAS评分平均(1.17±0.99)分,传统组为(1.32±1.14)分(t=-0.459,P= 0.649)；导航组ODI平均22.39%±9.08%,传统组为25.04%±10.64% (t= -0.855,P=0.397)；两组间比较差异均无统计学意义。末次随访时两组患者腿痛VAS评分、ODI均低于术前,差异具有统计学意义(P<0.05)。结论：导航与非导航辅助下经皮内镜椎间孔入路治疗腰椎侧方椎管狭窄症均可获得良好的临床疗效,导航辅助下椎间孔镜治疗腰椎侧方椎管狭窄症具有缩短手术时间,最大限度地减少手术的射线暴露并达到精准减压的优点。

Abstract:

Objective: To describe the surgical methodology and early clinical efficacy of percutaneous endoscopic transforaminal decompression (PETD) assisted by SEESSYS for lateral lumbar spinal canal (LLSC) stenosis. Methods: 43 patients with single-segment lumbar lateral spinal canal stenosis were included in the study during December 2018 to September 2019. PETD assisted by SEESSYS was performed in 18 patients (navigation group), including 7 males and 11 females, aged 35-80 years, with an average age of 58.22±13.59 years. 25 patients (traditional group) underwent PETD with C-arm fluoroscopy, including 12 males and 13 females, aged 35-85 years, with an average age of 56.16±13.30 years. The operation time, the number of intraoperative fluoroscopy were recorded. Visual analog scale (VAS) and Oswestry disability index (ODI) were compared between the two groups. The clinical efficacy was evaluated at the last follow-up using the modified Macnab criteria. Results: All of 43 patients were followed for at least 6 months. The average operation time of the navigation group was 68.56±24.53 min, and 86.44±30.46 min in the traditional group (t=-2.055, P=0.046). The average number of fluoroscopy in navigation group was 6.17±2.45 times, and that in traditional group was 17.12±9.33 times (t=-5.607, P<0.001). All these parameters had statistical significance (P<0.05). At the last follow-up, the average VAS score of the low back pain was 1.78±0.94 in navigation group, and 2.00±1.19 in traditional group (t=-0.657, P=0.515). The average VAS score of leg pain in navigation group was 1.17±0.99, traditional group was 1.32±1.14 (t=-0.459, P=0.649). ODI of navigation group was 22.39%±9.08%, and ODI of traditional group was 25.04%±10.64% (t=-0.855, P=0.397). There was no significant difference between the groups for VAS score and ODI. At the last follow-up, the VAS score and ODI of leg pain were lower than preoperative in the two groups, and the difference was significant (P<0.05). Conclusion: Both the navigation and non-navigation-assisted PETD can achieve excellent clinical results in the treatment of lumbar lateral spinal canal stenosis. The SEESSYS- assisted PETD has the advantages of shortening the operation time, minimizing the radiation exposure of the operation and achieving precise decompression.