椎间孔镜治疗退行性腰椎管狭窄症疗效分析及术后复发因素分析高正添贾天阳常成兵陈宾摘要：目的分析經皮椎间孔镜治疗退行性腰椎管狭窄症疗效并统计术后复发病例，分析其发生原因，并归纳相关危险因素。方法选取我科经皮椎间孔镜治疗退行性腰椎管狭窄症手术共188例进行为期1年的随访，分析手术疗效并对复发病例行二次椎间孔镜治疗，探讨术后复发原因，归纳相关危险因素。结果本组术后评分改善明显，术后1年优良率为88.83%;术后共出现复发患者6例，占总数3.19%，复发原因为术中髓核摘除不彻底、术中定位不佳、术前合并终板炎、术后活动过多等;均经二次PELD治疗逐渐康复，术后1年改良MacNab疗效评定4例优，1例良，1例可;术前合并终板炎9例，其中3例复发。结论经皮椎间孔镜治疗退行性腰椎管狭窄症的短期疗效确切，安全性高，术前合并终板炎可能为影响术后复发的高危因素，术前严格掌握手术适应证、把控相关危险因素、提高手术技巧可降低术后复发率。关键词：椎间孔镜;复发;危险因素;腰椎管狭窄：R687.3：ADOI：10.3969/j.issn.1006-1959.2019.01.035：1006-1959（2019）01-0115-04AnalysisoftheEfficacyofIntervertebralForamenintheTreatmentofDegenerativeLumbarSpinalStenosisandAnalysisofPostoperativeRecurrenceFactorsGAOZheng-tian，JIATian-yang，CHANGCheng-bing，CHENBin（DepartmentofSpinalSurgery，AffiliatedHospitalofChengdeMedicalCollege，Chengde067000，Hebei，China）Abstract：ObjectiveToanalyzetheefficacyofpercutaneoustransforaminallumbarstenosisinthetreatmentofdegenerativelumbarspinalstenosisandtoanalyzetherecurrencecases，andtoanalyzethecausesandsummarizetherelatedriskfactors.MethodsAtotalof188patientswithdegenerativelumbarspinalstenosisunderwentpercutaneoustransluminalangioplastyforone-yearfollow-up.Thecurativeeffectwasanalyzedandthepatientswithrecurrentcasesweretreatedwithsecondaryintervertebralforamen.Inductionofrelevantriskfactors.ResultsThepostoperativescoresofthisgroupimprovedsignificantly.Theexcellentandgoodratewas88.83%after1year.Therewere6casesofrecurrenceafteroperation，accountingfor3.19%ofthetotal.Therecurrencewasduetoincompletenucleuspulposusremovalandpoorintraoperativepositioning.Preoperativecombinedendplateinflammation，excessivepostoperativeactivities，etc.;allgraduallyrecoveredbysecondaryPELDtreatment，4casesofimprovedMacNabefficacyafter1yearofsurgery，1caseisgood，1casewasavailable;9casesofendplateinflammationwerecombinedbeforeoperation，and3casesrecurred.ConclusionTheshort-termcurativeeffectofpercutaneoustransforaminallumbarstenosisfordegenerativelumbarspinalstenosisissafeandhigh.Preoperativecombinedendplateinflammationmaybeariskfactorforpostoperativerecurrence.Surgicalindicationsandcontrolarestrictlycontrolledbeforeoperation.Riskfactorsandimprovedsurgicalskillscanreducetherecurrencerate.Keywords：Intervertebralforamen;Recurrence;Riskfactors;Lumbarspinalstenosis经皮椎间孔镜下髓核摘除术（percutaneousendoscopiclumbardiscectomy，PELD）作为一项新兴的脊柱微创手术方法，在治疗腰间盘突出症（lumbardischerniation，LDH）的疗效上已经得到了业内的广泛认可[1]，但退行性腰椎管狭窄症（degenerativelumbarspinalstenosisdisease，DLSS）病因复杂，好发于老年人，手术难度大，因此其微创治疗仍有争议[2]。目前开放手术仍是临床上治疗DLSS的传统治疗方式，其中经椎间孔入路腰椎椎间植骨融合术（TLIF）是治疗DLSS的金标准，但手术创伤较大，术后易出现邻椎病等并发症[3]。DLSS患者一般高龄，基础疾病较多，常常不能耐受手术及全身麻醉风险，因此PELD开始应用于DLSS患者[4]。与传统手术相比PELD微创优势明显;且对椎管内正常的结构破坏小，术后椎管内局部瘢痕形成少，对日后可能的二次手术影响相对较小[5]。我...