单孔分体内镜治疗中重度腰椎管狭窄症的早期临床疗效

Preliminary clinical outcomes of one-hole split endoscopy for treating moderate-severe lumbar spinal stenosis

目的:对比分析应用单孔分体内镜(one-hole split endoscope,OSE)技术和单侧双通道内镜(unilateral biportal endoscopy,UBE)技术治疗中重度腰椎管狭窄症的早期临床疗效.方法:回顾性分析我科2021年1月~2021年7月采用OSE技术和UBE技术治疗的159例中重度腰椎管狭窄症患者的临床资料,其中UBE组80例,男32例,女48例,年龄59.63±7.97岁,体质指数(body mass index,BMI)23.27±1.73kg/m^(2),L3/4节段10例,L4/5节段45例,L5/S1节段25例,单侧减压47例,双侧减压33例;OSE组79例,男37例,女42例,年龄56.70±11.75岁,BMI 23.64±1.76kg/m^(2),L3/4节段8例,L4/5节段50例,L5/S1节段21例,单侧减压48例,双侧减压31例.统计并比较两组患者住院时间、手术时间、切口长度、出血量,手术前后腰椎动力位X线片的手术节段活动度(range of motion,ROM)及矢状位平移量(sagittal translation,ST)、手术节段三维CT轴位关节面长度及小关节内切角度、MRI T2加权像轴位手术节段椎管横截面积.术前、术后次日、3个月、1年采用疼痛视觉模拟评分(visual analogue score,VAS)评估腰痛和腿痛程度,采用改良Oswestry功能障碍指数(Oswestry disability index,ODI)评估功能改善情况,末次随访采用改良Macnab评估临床疗效.分析并比较两组手术前后临床评分结果.结果:所有患者均顺利完成手术,OSE组与UBE组住院时间、手术时间、术中出血量比较差异均无统计学意义(P>0.05).与UBE组相比,OSE组切口更小(2.12±0.22cm vs 2.70±0.40cm),差异有统计学意义(P<0.05).两组患者术后次日、3个月、1年的腰痛及下肢VAS评分均较术前明显改善(P<0.05),术后3个月、1年的ODI评分均较术前明显改善(P<0.05),组内各时间点两两比较差异均有统计学意义(P<0.05),两组间差异无统计学意义(P>0.05).两组术前术后手术节段ST、ROM比较及两组间比较差异均无统计学意义(P>0.05).术后小关节内切角度及关节突保留率两组间比较差异无统计学意义(P>0.05).两组术后手术节段椎管横截面积较术前明显增大,差异具有统计学意义(P<0.05),两组间比较差异无统计学意义(P>0.05).术后1年优良率两组间比较差异无统计学意义(P>0.05).结论:与UBE技术一样,应用OSE技术治疗中重度腰椎管狭窄症,减压充分,早期临床疗效确切,远期疗效需进一步随访.

Objectives:T:o compare the early clinical efficacy of one-hole split endoscopy(OSE)and unilateral biportal endoscopy(UBE)technique in the treatment of moderate-severe lumbar spinal stenosis.Methods:Patients with moderate-severe lumbar spinal stenosis treated via OSE and UBE techniques in our department from January 2021 till July 2021 were analyzed retrospectively.According to the inclusion criteria,159 patients were included,which were divided into OSE group and UBE group.There were 80 cases in the UBE group(32 males and 48 females)averaged 59.63±7.97 years old,with a mean body mass index(BMI)of 23.27±1.73kg/m^(2);10 cases were operated at L3/4,45 cases at L4/5,and 25 cases at L5/S1;47 cases were decompressed unilaterally and 33 cases bilaterally.OSE group consisted of 79 cases(37 males and 42 females)averaged 56.70±11.75 years old,with a BMI of 23.64±1.76kg/m^(2);8 cases were operated at L3/4,50 cases at L4/5,and 21 cases at L5/S1;48 cases were decompressed unilaterally and 31 cases bilaterally.Data such as length of hospitalization,,operation time,incision length,and intraoperative blood loss were counted and compared between groups.Moreover,range of motion(ROM)and sagittal translation(ST)on lumbar dynamic Xrays,axial articular surface length and angle of the cutting surface of the facet joint of 3D CT,and axial spinal canal cross-sectional area of T2-weighted MRI of the surgical segment before and after operation were recorded.The visual analogue scale(VAS)was employed to evaluate of low back and leg pain before operation and at different time points(the second day,3 months,1 year)after surgery,the Oswestry disability index(ODI)was used to evaluate functional improvement,and the clinical efficacy was evaluated by modified Macnab criteria at final follow-up.All the clinical scores before and after surgery were analyzed and compared between groups.Results:All the patients underwent surgical intervention successfully.There was no statistical significance in length of hospitalization,operation time or intraoperative blood loss between groups(P>0.05).Comparing with the UBE group,the OSE group had smaller incision length(2.12±0.22cm vs 2.70±0.40cm),and the difference was statistically significant(P<0.05).The VAS scores for low back and leg pain on the next day afteroperation,at three-month and one-year of both groups were significantly improved than those preoperatively(P<0.05).The ODI at postoperative three-month and one-year were significantly lower than those preoperatively(P<0.05).The values at each time point within groups were significantly different when compared pairwise(P<0.05),while no significant difference was found between the two groups(P>0.05).There was no statistical significance between preoperative and postoperative ST and ROM of surgical segment respectively of both groups,and there was no statistical significance between groups(P>0.05).There was no significant difference in angle of facetectomy and facet preservation rate between the two groups(P>0.05).The spinal canal cross-sectional area of the surgical segment postoperatively of both groups were significantly larger than those preoperatively with statistical difference(P<0.05),but there was no significant difference between the two groups(P>0.05).There was no significant difference in the excellent and good rate between the two groups 1 year after operation(P>0.05)Conclusions::OSE technique and UBE technique can achieve sufficient decompression for the treatment of moderate and severe lumbar spinal stenosis with certain early clinical efficacy,and the long-term efficacy requires further follow-up.