单侧双通道内窥镜技术治疗腰椎椎管狭窄症

Unilateral biportal endoscopic technique for lumbar spinal stenosis

目的对比分析单侧双通道内窥镜(UBE)技术及传统腰椎后路椎板减压术治疗腰椎椎管狭窄症(LSS)的安全性和临床疗效。方法2018年5月—2021年6月,宁波市康复医院收治60岁以上LSS患者73例,其中35例采用UBE技术治疗(UBE组),38例采用传统开放腰椎后路椎板减压术治疗(对照组)。记录2组患者手术时间、术中出血量、术后恢复时间、住院时间及并发症发生情况。术前及术后3、6、12个月时采用疼痛视觉模拟量表(VAS)评分和Oswestry功能障碍指数(ODI)评估腰腿痛程度及腰椎功能。采用改良MacNab标准评估疗效。结果所有手术顺利完成,所有患者随访(10.9±0.8)个月。与对照组相比,UBE组术中出血量更少,手术时间、术后恢复时间、住院时间更短,差异均有统计学意义(P<0.05)。2组术后各随访时间点VAS评分、ODI较术前明显改善,UBE组术后12个月VAS评分优于对照组,UBE组术后各随访时间点ODI优于对照组,差异均有统计学意义(P<0.05)。改良MacNab标准评价疗效,UBE组疗效优良率为82.85%,对照组为78.94%,差异有统计学意义(P<0.05)。UBE组发生伤口感染1例;对照组发生伤口感染3例,脑脊液漏1例,神经牵拉伤1例;经对症处理后均明显改善。结论相较于传统腰椎后路椎板减压术,UBE技术可以安全有效地对LSS患者进行减压,具有创伤小,出血量少,手术时间、术后恢复时间及住院时间短,术后并发症少等诸多优势,值得临床优先选择。

Objective To compare the safety and clinical efficacy of unilateral biportal endoscopic(UBE)technique and traditional posterior lumbar laminectomy in the treatment of lumbar spinal stenosis(LSS).Methods From May 2018 to June 2021,73 patients with LSS over 60 years old were treated in Ningbo Rehabilitation Hospital,of which 35 were treated with UBE technique(UBE group),and 38 with traditional open posterior lumbar laminectomy(control group).The operation time,intraoperative blood loss,postoperative recovery time,hospital stay and complications of the 2 groups were recorded.The visual analogue scale(VAS)score and Oswestry Disability Index(ODI)were used to evaluate the intensity of low back and leg pain and lumbar function before operation and at 3,6,and 12 months after operation.Therapeutic effect was assessed using modified MacNab criteria.Results All the operations were successfully completed,and patients were followed up fo(r 10.9±0.8)months.Compared with the control group,the UBE group had less intraoperative blood loss,shorter operation time,postoperative recovery time and hospital stay,all with a statistically significant difference(P<0.05).The VAS scores and ODI of the 2 groups at each follow-up time point were significantly improved compared with those before operation,all with a statistically significant difference(P<0.05).The VAS score of UBE group was better than that of the control group at 12 months after operation,and the ODI of UBE group was better than that of the control group at all follow-up time points,and the differences were statistically significant(P<0.05).The excellent and good rate of therapeutic effect was 82.85%in the UBE group and 78.94%in the control group,and the difference was statistically significant(P<0.05).Wound infection occurred in 1 case in UBE group.In the control group,there was wound infection in 3 cases,cerebrospinal fluid leakage in 1 and nerve traction injury in 1.After symptomatic treatment,all of them were significantly improved.Conclusion Compared to traditional posterior lumbar laminectomy,UBE can safely and effectively decompress patients with LSS,with many advantages such as less trauma,less blood loss,shorter operation time,postoperative recovery time and hospital stay,less postoperative complications,thus being worthy of clinical priority.