单侧双通道内窥镜辅助下单侧椎板切除双侧减压治疗退行性腰椎管狭窄症

Unilateral biportal endoscopic-assisted unilateral laminectomy and bilateral decompression for degenerative lumbar spinal stenosis

目的探讨单侧双通道内窥镜(UBE)辅助椎板切除术治疗退行性腰椎管狭窄症(LSS)的临床效果和安全性。方法回顾性分析2019年7月至2020年12月湛江岭南医院收治、采用UBE辅助下单侧椎板切除双侧减压手术治疗的45例退行性LSS患者的临床资料。记录手术时间、术中出血量、住院时间和并发症发生情况,观察患者手术前后腰背部和下肢视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)变化,采用改良MacNab标准评估患者满意度。结果手术时间(96.6±23.2)min,术中出血量(80.3±15.1)mL,住院时间(6.1±1.1)d。术后1周、末次随访患者腰背部和下肢VAS评分、ODI均较术前改善,手术前后比较,差异有统计学意义(P<0.05)。随访期间影像学示腰椎管扩大,脊髓及神经根无压迫,未见节段性不稳发生。根据改良MacNab标准,末次随访时优29例、良13例、一般3例,优良率为93%。结论UBE辅助下单侧椎板切除双侧减压技术治疗退行性LSS安全有效,具有手术节段稳定性良好、学习曲线短的优点。

Objective To explore the clinical efficacy and safety of unilateral biportal endoscopy(UBE)assisted laminectomy for degenerative lumbar spinal stenosis(LSS).Methods Clinical data of 45 patients with degenerative LSS who underwent UBE assisted unilateral laminectomy and bilateral decompression from July 2019 to December 2020 in Zhanjiang Lingnan Hospital were retrospectively analyzed.Operation time,estimate intraoperative blood loss,hospitalization stay and complications were recorded,Changes of preoperative and postoperative visual analogue scale(VAS)score of low back and lower extremity,and Oswestry disability index(ODI)were observed,patients'satisfaction was evaluated by modified MacNab criteria.Results Operation time was(96.6±23.2)min,estimate intraoperative blood loss was(80.3±15.1)mL,and hospitalization stay was(6.1±1.1)d.VAS scores of low back and lower limbs as well as ODI of the patients at 1 week postoperatively and at the latest follow-up were all improved when compared with preoperative ones,which showed statistical differences between preoperation and postoperation(P<0.05).During the follow-up,radiology examinations showed that the stenosis of lumbar spinal canal was recovered,no compression of spinal cord or nerve root was found,also,no segmental instability was observed.According to the modified MacNab standard,there were excellent in 29 cases,good in 13 and fair in 3 with excellent and good rate of 93%at the latest follow-up.Conclusion UBE assisted unilateral laminectomy and bilateral decompression is safe and effective for degenerative LSS,and has the advantages of high stability of cervical segments and short learning curve.