经皮全脊柱内镜技术治疗青少年腰椎椎体后缘离断症Percutaneous full-endoscopic technique for treatment of posterior lumbar apophyseal ring fractures in adolescents
薛静波;晏怡果;王文军;王程;李丹;李学林;欧阳智华;
摘要(Abstract):
[目的]探讨经皮全脊柱内镜技术治疗青少年腰椎椎体后缘离断症的疗效。[方法]2012年9月~2015年9月采用经皮全脊柱内镜技术治疗腰椎椎体后缘离断症患者28例,男17例,女11例;年龄16~25岁,平均18.80岁。责任节段L_(2/3)1例、L_(3/4)6例、L_(4/5)15例、L_5/S_1 6例。25例采用经椎间孔入路,3例采用经椎板间入路。[结果]手术时间60~170 min,平均90 min。1例经椎板间隙入路手术术中发生硬脊膜撕裂而中转开放手术,所有病例均未出现神经根及马尾损伤并发症。1例术后第5 d出现手术节段椎间盘突出,采用显微内窥镜下椎间盘摘除术翻修;其余26例患者随访12~36个月,平均18.80个月。末次随访时VAS评分由术前的(5.81±2.73)分下降至(1.63±1.12)分(P<0.05),腿痛VAS评分由术前的(5.74±2.30)分下降至(0.81±0.55)分(P<0.05),ODI由术前的(52.55±19.22)%降至(11.88±7.60)%(P<0.05)。Mac Nab法疗效评定结果优18例、良7例、可1例。[结论]经皮全脊柱内镜技术治疗青少年腰椎椎体后缘离断症能保留腰椎活动度、明显缓解症状,术后近期疗效良好。术后12个月腰椎MRI显示手术节段椎体后缘获得良好塑型。
关键词(KeyWords): 腰椎;椎体后缘离断;脊柱内镜;脊柱手术;微创
基金项目(Foundation):
作者(Author): 薛静波;晏怡果;王文军;王程;李丹;李学林;欧阳智华;
Email:
DOI:
参考文献(References):
- [1]Yang IK,Bahk YW,Choi KH,et al.Posterior lumbar apophyseal ring fractures:a report of 20 cases[J].Neuroradiology,1994,36(6):453-455.
- [2]Sairyo K,Goel VK,Masuda A,t al.Three dimensional finite element analysis of the pediatric lumbar spine.Part II:biomechanical change as the initiating factor for pediatric isthmic spondylolisthesis at the growth plate[J].Eur Spine J,2006,15(6):930-935.
- [3]Yen CH,Chan SK,Ho YF,et al.Posterior lumbar apophyseal ring fractures in adolescents:a report of four cases[J].J Orthop Surg(Hong Kong),2009,17(1):85-89.
- [4]Wu X,Ma W,Du H,et al.A review of current treatment of lumbar posterior ring apophysis fracture with lumbar disc herniation[J].Eur Spine J,2013,22(3):475-488.
- [5]Ahn Y,Jang IT,Kim WK,et al.Transforaminal percutaneous endoscopic lumbar discectomy for very high-grade migrated disc herniation[J].Clin Neurol Neurosurg,2016,147(1):11-17.
- [6]Li ZZ,Hou SX,Shang WL,et al.Percutaneous lumbar foraminoplasty and percutaneous endoscopic lumbar decompression for lateral recess stenosis through transforaminal approach:technique notes and 2 years follow-up[J].Clin Neurol Neurosurg,2016,143(1):90-94.
- [7]Deleo T,Merotto S,Smith C,et al.A posterior ring apophyseal fracture and disc herniation in a 21-year-old competitive basketball player:a case report[J].J Can Chiropr Assoc,2015,59(4):373-382.
- [8]Miyagi R,Sairyo K,Sakai T,et al.Persistent tight hamstrings following conservative treatment for apophyseal ring fracture in adolescent athletes:critical appraisal[J].J Med Invest,2014,61(3-4):446-451.
- [9]刘则征,黎庆初,杨洋,等.显微内窥镜辅助下手术治疗青少年腰椎椎体后缘骨骺离断症合并腰椎椎间盘突出症[J].脊柱外科杂志,2015,13(6):322-326.
- [10]Smith N,Masters J,Jensen C,et al.Systematic review of microendoscopic discectomy for lumbar disc herniation[J].Eur Spine J,2013,22(11):2458-2465.
- [11]Kim CH,Shin KH,Chung CK,et al.Changes in cervical sagittal alignment after single-level posterior percutaneous endoscopic cervical diskectomy[J].Global Spine J,2015,5(1):31-38.