目的 探讨经皮单通道显微减压术治疗退行性腰椎管狭窄症（DLSS）的疗效。 方法 回顾性选择解放军联勤保障部队第九〇〇医院神经外科自2018年10月至2023年4月收治的无节段性腰椎失稳影像学表现的117例DLSS患者为研究对象，所有患者均经严格保守治疗无效后改行显微镜与经皮通道系统联合应用下单通道入路腰椎后路椎管和神经根减压术治疗，术后随访6~50个月。分析患者术前1 d、术后1周及末次随访时疼痛视觉模拟量表（VAS）评分、腰椎Oswestry功能障碍指数（ODI）以及腰椎X线、CT、MRI复查情况，并于末次随访时采用改良MacNab标准评价疗效。 结果 117例患者中，实施单侧椎板切开单侧减压56例（47。9%），单侧椎板切开双侧减压61例（52。1%）；实施单节段减压109例（93。2%），双节段减压8例（6。8%）。术中发生硬膜囊撕裂4例（3。5%），即刻予以封堵，术后无脑脊液漏发生。所有患者术中均未发生明显的神经损伤，术后均未发生椎间隙感染或腰椎不稳。所有患者随访18（13，24）个月，末次随访时的VAS评分由术前1 d的（5。96±0。85）分、术后1周的（1。75±0。61）分降至（1。01±0。59）分，腰椎ODI由术前1 d的（63。22±8。33）%、术后1周的（17。66±5。20）%降至（10。64±3。44）%，差异均有统计学意义（P<0。05）。末次随访时，改良MacNab标准为优46例（39。3%）、良66例（56。4%）、可3例（2。6%）、差2例（1。7%），疗效优良率为95。7%。 结论 对于术前无腰柱失稳证据的DLSS患者，经皮通道系统联合显微镜下单通道入路个体化实施单侧或双侧椎管内减压术，在有效减少手术创伤的同时，亦可获得满意的手术效果。 Objective To investigate the efficacy of microscopic decompression in degenerative lumbar spinal stenosis (DLSS) under single percutaneous tubular retractor system。 Methods A retrospective analysis was performed 117 DLSS patients with imaging manifestations as non-segmental lumbar instability， admitted to Department of Neurosurgery， 900th Hospital of PLA Joint Logistics Team from October 2018 to April 2023 were enrolled consecutively。 These patients failed in strict conservative treatment and then changed to posterior lumbar spinal canal and nerve root decompression by microscopy and percutaneous tubular retractor system。 These patients were followed up for 6-50 months。 Pain visual analogue score (VAS) and lumbar Oswestry dysfunction index (ODI) were recorded and results of X-rays， CT and MRI of lumbar spines were analyzed 1 d before and 1 week after decompression and at the last follow-up。 Modified MacNab criteria were used to evaluate the efficacy at the last follow-up。 Results Among the 117 patients， unilateral laminectomy for unilateral decompression was performed in 56 patients (47。9%) and unilateral laminotomy for bilateral decompression in 61 (52。1%)。 Single segment decompression was performed in 109 patients (93。2%) and double segment decompression in 8 (6。8%)。 Dural sac rupture occurred in 4 patients (3。5%)， and immediate occlusion was given no cerebrospinal fluid leakage was noted after decompression。 All patients did not experience obvious nerve damage during decompression or intervertebral infection/lumbar instability after decompression。 After 18 (13， 24) months of follow-up， VAS scores of the patients at the last follow-up decreased from (5。96±0。85) 1 d before decompression and (1。75±0。61) 1 week after decompression to (1。01±0。59)， and lumbar ODI decreased from (63。22±8。33)% 1 d before decompression and (17。66±5。20)% 1 week after decompression to (10。64±3。44)%， with significant differences (P<0。05)。 At the last follow-up， modified MacNab criteria indicated 46 patients (39。3%) as excellent， 66 (56。4%) as good， 3 (2。6%) as fair， and 2 (1。7%) as poor， with an excellent/good therapeutic rate of 95。7%。 Conclusion For surgical treatment of DLSS patients without evidenced preoperative spinal instability， personalized unilateral or bilateral spinal canal decompression under microscope by combiningsingle percutaneous tubular retractor system can effectively reduce surgical trauma and achieve satisfactory surgical results。
Efficacy of microscopic decompression in degenerative lumbar spinal stenosis under single percutaneous tubular retractor system
Objective To investigate the efficacy of microscopic decompression in degenerative lumbar spinal stenosis (DLSS) under single percutaneous tubular retractor system. Methods A retrospective analysis was performed 117 DLSS patients with imaging manifestations as non-segmental lumbar instability, admitted to Department of Neurosurgery, 900th Hospital of PLA Joint Logistics Team from October 2018 to April 2023 were enrolled consecutively. These patients failed in strict conservative treatment and then changed to posterior lumbar spinal canal and nerve root decompression by microscopy and percutaneous tubular retractor system. These patients were followed up for 6-50 months. Pain visual analogue score (VAS) and lumbar Oswestry dysfunction index (ODI) were recorded and results of X-rays, CT and MRI of lumbar spines were analyzed 1 d before and 1 week after decompression and at the last follow-up. Modified MacNab criteria were used to evaluate the efficacy at the last follow-up. Results Among the 117 patients, unilateral laminectomy for unilateral decompression was performed in 56 patients (47.9%) and unilateral laminotomy for bilateral decompression in 61 (52.1%). Single segment decompression was performed in 109 patients (93.2%) and double segment decompression in 8 (6.8%). Dural sac rupture occurred in 4 patients (3.5%), and immediate occlusion was given no cerebrospinal fluid leakage was noted after decompression. All patients did not experience obvious nerve damage during decompression or intervertebral infection/lumbar instability after decompression. After 18 (13, 24) months of follow-up, VAS scores of the patients at the last follow-up decreased from (5.96±0.85) 1 d before decompression and (1.75±0.61) 1 week after decompression to (1.01±0.59), and lumbar ODI decreased from (63.22±8.33)% 1 d before decompression and (17.66±5.20)% 1 week after decompression to (10.64±3.44)%, with significant differences (P<0.05). At the last follow-up, modified MacNab criteria indicated 46 patients (39.3%) as excellent, 66 (56.4%) as good, 3 (2.6%) as fair, and 2 (1.7%) as poor, with an excellent/good therapeutic rate of 95.7%. Conclusion For surgical treatment of DLSS patients without evidenced preoperative spinal instability, personalized unilateral or bilateral spinal canal decompression under microscope by combiningsingle percutaneous tubular retractor system can effectively reduce surgical trauma and achieve satisfactory surgical results.
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