单侧双通道内镜与单通道内镜治疗腰椎管狭窄症的疗效及影响因素分析

Efficiency and influence factors analysis of unilateral biportal approach endoscopy and unilateral approach endoscopy in the treatment of lumbar spinal stenosis

目的分析单侧双通道内镜与单通道内镜椎板间入路双侧椎管减压术(unilateral laminectomy for bilateral decompression,ULBD)治疗腰椎管狭窄症的疗效及影响因素。方法采取回顾性研究,收集2020年1月至2022年12月贵州省遵义市播州区人民医院收治的120例腰椎管狭窄症患者临床资料。按手术方式分为单侧双通道内镜ULBD术组(双通道组,n=51)和单侧单通道内镜ULBD术组(单通道组,n=69)。统计并比较两组患者术后3个月时MacNab标准评估的优良率;记录手术时间、术中出血量和住院时间;比较术前、术后3个月的VAS评分、JOA评分及ODI评分。并将腰椎管狭窄症患者术后按照临床疗效分为有效组、无效组,统计并比较两组的基线资料,采用Logistic回归分析造成腰椎管狭窄症患者术后治疗无效的危险因素。结果双通道组的优良率(84.31%)与单通道组(81.16%)比较,差异无统计学意义(P>0.05);双通道组的手术时间短于单通道组,两组间比较差异具有统计学意义(P<0.05);两组术中出血量比较,差异无统计学意义(P>0.05);双通道组的住院时间长于单通道组,两组间比较差异具有统计学意义(P<0.05)。术后3个月两组的VAS、ODI评分低于术前,JOA评分高于术前,差异有统计学意义(P<0.05);术后3个月的两组间的VAS、JOA、ODI评分比较,差异无统计学意义(P>0.05)。无效组年龄≥75岁,髓内信号为水肿型、囊变型,术前腰椎失稳,术前纤维环破裂患者占比高于有效组,病程相较于有效组长(P<0.05);建立二元Logistic回归模型,结果显示,年龄≥75岁,病程长,髓内信号为水肿型、囊变型,术前腰椎失稳,术前纤维环破裂是腰椎管狭窄症患者ULBD术治疗无效的危险因素(OR>1,P<0.05)。结论单侧双通道内镜与单通道内镜ULBD术对腰椎管狭窄症患者均有较好的治疗效果,其中双通道具有手术时间短的优势,同时年龄≥75岁,髓内信号为水肿型、囊变型,术前腰椎失稳,术前纤维环破裂是导致腰椎管狭窄症患者术后治疗效果较差的危险因素。

Objective To analyze the efficacy and influence factors of unilateral laminectomy for bilateral decompression(ULBD)through unilateral biportal approach endoscopy and unilateral approach endoscopy interlaminar approach for the treatment of lumbar spinal stenosis.Methods A retrospective study was conducted to collect clinical data of 120 patients with lumbar spinal stenosis admitted to Bozhou District People's Hospital,Zunyi City from January 2020 to December 2022.All patients were divided into unilateral biportal approach endoscopy ULBD group(dual channel group,n=51)and unilateral approach endoscopy ULBD group(single channel group,n=69)according to surgical methods.The study evaluated clinical efficacy according to MacNab at 3 months post-surgery,along with surgical indicators such as operation time,intraoperative blood loss and hospital stay,as well as VAS,JOA,and ODI scores before and 3 months after surgery.Patients with lumbar spinal stenosis were divided into effective and ineffective groups according to clinical efficacy after surgery.The baseline data from both groups underwent statistical analysis and comparison.Logistic regression analysis was utilized to examine the risk factors for ineffective postoperative treatment in patients with lumbar spinal stenosis.Results There was no significant difference in the excellent and good rate of the dual channel group(84.31%)and single channel group(81.16%)(P>0.05).The operation time in the dual channel group was shorter than that in the single channel group(P<0.05);there was no significant difference in the intraoperative blood loss between the two groups(P>0.05);the hospital stay in the dual channel group was longer than that in the single channel group(P<0.05).After treatment,the VAS and ODI scores of the two groups were lower than before treatment,while the JOA scores were higher than before treatment(P<0.05);and there were no significant differences in the VAS,JOA,ODI scores between the two groups(P>0.05).The proportion of patients in the ineffective group aged≥75 years old,with edema type,cystic transformation type,preoperative lumbar instability,and annulus fibrosus rupture in the intramedullary signal,was higher than that in the effective group,and the disease course was longer than that in the effective group(P<0.05).A binary logistic regression model was established,and the results showed that age≥75 years old,long course of disease,edema type intramedullary signal,cystic transformation,preoperative lumbar instability,and preoperative rupture of the fibrous ring were risk factors for ineffective ULBD treatment in patients with lumbar spinal stenosis(OR>1,P<0.05).Conclusion Both unilateral biportal approach endoscopy and unilateral approach endoscopy ULBD have good therapeutic effects on patients with lumbar spinal stenosis,among which dual channel surgery has the advantage of short surgical time.At the same time,age≥75 years old,intramedullary signals of edema type,cystic transformation type,preoperative lumbar instability,and fiber ring rupture are risk factors for poor postoperative treatment effect in patients with lumbar spinal stenosis.