黄韧带整块切除技术在双通道脊柱内镜下腰椎管减压术中的应用及临床疗效

The application and clinical efficiency of unilateral biportal endoscopic unilateral laminotomy for bilateral decompression with ligamentum flavum en bloc resection

目的 观察分析双通道脊柱内镜下单侧入路双侧椎管减压术 (unilateral biportal endoscopic unilateral laminotomy for bilateral decompression,UBE-ULBD) 治疗腰椎管狭窄症的临床疗效,并探讨黄韧带整块切除技术的应用技巧及意义。方法 2019 年 11 月至 2020 年 12 月,我院采用 UBE-ULBD 治疗腰椎管狭窄症患者 30 例,其中男 13 例,女 17 例;年龄 50~78 岁,平均 (62.3±8.2) 岁。单节段狭窄 24 例,双节段狭窄 6 例,共计 36 个手术减压节段,其中 L;节段 6 例,L;节段 25 例,L;~S;节段 5 例。术中采用黄韧带整块切除技术去除黄韧带。术前及术后随访时应用腰痛及下肢疼痛视觉模拟评分 (visual analogue scale,VAS)、Oswestry 功能障碍指数 (oswestry disability index,ODI) 进行评估,同时采用改良 MacNab 标准评估临床疗效。记录手术时间、术后引流量、术后住院时间和并发症。结果 所有患者均顺利完成手术,单节段手术时间(85.8±9.4) min,术后引流量 (17.1±16.6) ml,术后住院时间 (2.4±0.6) 天,术后平均随访 (15.3±3.5) 个月。术前和术后 1 天、3 个月、6 个月以及末次随访时患者腰痛 VAS 评分分别是 3.8±1.1,3.2±0.7,1.7±0.6,1.3±0.7,1.2±0.9;下肢痛 VAS 评分分别是 6.2±1.0,2.0±1.0,1.5±0.8,1.3±0.7,1.1±0.9。术前和术后 3 个月、6 个月以及末次随访时患者 ODI 分别是 66.8±9.4,19.6±6.0,13.4±4.6,11.7±3.8,术后腰腿痛 VAS 评分及 ODI 评分均较术前明显改善,差异有统计学意义 (P < 0.01)。末次随访时按照改良 MacNab 标准评估临床疗效:优 23 例,良 5 例,可 2 例,优良率为 93.3%。结论 UBE-ULBD 治疗腰椎管狭窄症能够实现椎管的彻底减压,创伤小、恢复快,能够获得良好的临床疗效,并且具有简化操作流程、缩短手术时间、减少硬膜撕裂风险的潜在价值。

Objective To evaluate the clinical efficiency of unilateral biportal endoscopic unilateral laminotomy for bilateral decompression (UBE-ULBD) in the treatment of lumbar spinal stenosis (LSS),and to investigate the technique and application of ligamentum flavum en bloc resection.Methods From November 2019 to December 2020,30 patients (13 males and 17 females) with lumbar spinal stenosis underwent UBE-ULBD.There were 36 decompression levels including 24 cases with single level and 6 cases with double levels.There were 6 levels of L;,25 levels of L;and 5 levels of L;/ S;.During the UBE-ULBD,the ligamentum flavum en bloc resection was applied in all cases.The Visual Analogue Scale (VAS) for the back and leg pain,Oswestry Disability Index (ODI) and modified MacNab criteria were used to analyze the clinical efficiency.The details of operation time,postoperative drainage,postoperative hospital stay and complications were also recorded and analyzed.Results All UBE-ULBD were completed successfully.The operation time for single level was (85.8±9.4) min and the drainage was(17.1±16.6) ml.The postoperative length of stay was (2.4±0.6) d and the follow-up time was (15.3±3.5) m.The VAS-back pain preoperatively,1d,3m,6m postoperatively and at the last follow-up was (3.8±1.1),(3.2±0.7),(1.7±0.6),(1.3±0.7),(1.2±0.9),respectively,while the leg pain (6.2±1.0),(2.0±1.0),(1.5±0.8),(1.3±0.7),(1.1±0.9),respectively.The ODI preoperatively,3m,6m postoperatively and at the last follow-up was(66.8±9.4) %,(19.6±6.0) %,(13.4±4.6) %,(11.7±3.8) %,respectively.The postoperative VAS and ODI were significantly decreased compared with those of preoperation (P < 0.01).According to the modified MacNab criteria,there were 23 excellent cases,5 good cases,2 fair cases,with the excellent and good rate rate of 93.3%.Conclusions The UBE-ULBD with ligamentum flavum en bloc resection could completely achieve spinal decompression and satisfactory clinical outcomes with the merits of minimal invasive operation and fast recovery.The technique has the potential value to simplify the surgical procedure,shorten operation time and lower the risk of dura tear.