单侧双通道内镜技术治疗腰椎管狭窄症合并退行性脊柱侧弯的2种入路的比较研究

Comparison of Two Approaches of Unilateral Biportal Endoscopic Treatment for Lumbar Spinal Stenosis Complicated With Degenerative Scoliosis

目的探讨单侧双通道内镜技术(unlateral biportal endoscopy,UBE)凹、凸侧2种入路治疗腰椎管狭窄症合并退行性脊柱侧弯(lumbar spinal stenosis with degenerative scoliosis,LSS-DS)的疗效。方法回顾性分析我院2020年10月~2021年9月68例凹侧症状LSS-DS,以患者侧弯方向分为凹、凸侧,行凹侧入路单侧双通道内镜32例(凹侧入路组)或凸侧入路单侧双通道内镜36例(凸侧入路组),比较2组手术时间、关节突关节保留率、疼痛视觉模拟评分(Visual Analogue Scale,VAS)、Oswestry功能障碍指数(Oswestry Disability Index,ODI)、改良MacNab标准、术前后腰椎Cobb角、局部Cobb角及腰椎前凸角。结果所有患者均顺利完成手术。凹侧入路组手术时间明显短于凸侧入路组(t=-9.190,P=0.000);凹、凸侧入路组小关节突关节保留率分别为(85.74±2.95)%、(84.75±1.88)%,差异无显著性(t=1.659,P=0.102)。2组患者随访(12.1±3.2)月,与术前比较,术后2组腰腿痛VAS评分和ODI均显著降低(P<0.05),2组间差异均无统计学意义(P>0.05)。按照改良MacNab标准,凹侧入路组优良率90.6%(29/32),凸侧入路组优良率94.4%(34/36),差异无显著性(Z=-0.389,P=0.697)。末次随访2组术后腰椎Cobb角、局部Cobb角及腰椎前凸角与术前差异无统计学意义(P>0.05)。结论凹、凸侧2种入路UBE均可有效治疗LSS-DS,对腰椎稳定性影响均较小且无明显差异,直接症状侧入路可显著缩短手术时间,降低手术风险。

Objective To investigate the difference of curative effect between concave and convex approaches of unilateral biportal endoscopy(UBE)in the treatment of lumbar spinal stenosis with degenerative scoliosis(LSS-DS).Methods A retrospective analysis was conducted on 68 patients with LSS-DS with concave side symptoms admitted to our hospital from October 2020 to September 2021.The patients were classified into concave side or convex side according to the direction of scoliosis,among which 32 patients underwent concave approach unilateral biportal endoscopy(concave approach group)and 36 patients underwent convex approach unilateral biportal endoscopy(convex approach group).The operation time,percentage of preserved facet,preoperative and postoperative visual analogue scale(VAS)and Oswestry disability index(ODI),modified MacNab criteria,as well as preoperative and postoperative lumbar Cobb angle,local Cobb angle,and lumbar lordosis angle of the two groups were compared.Results All the patients received the operation smoothly.The operative time of the concave approach group was significantly shorter than that of the convex approach group(t=-9.190,P=0.000).The percentage of preserved facet was(85.74±2.95)%in the concave approach group and(84.75±1.88)%in the convex approach group,having no significant significance(t=1.659,P=0.102).Both groups were followed up for(12.1±3.2)months.As compared to preoperation,the VAS score of low back and leg pain and ODI in both groups significantly decreased after surgery(P<0.05),and there was no statistically significant difference between the two groups(P>0.05).According to the modified MacNab criteria,the excellent and good rate was 90.6%(29/32)in the concave approach group and 94.4%(34/36)in the convex approach group,with no significant difference(Z=-0.389,P=0.697).At the last follow-up,there was no significant difference in the Cobb angle,local Cobb angle and lumbar lordosis angle between the two groups(P>0.05).Conclusions Both concave and convex approaches of UBE can effectively treat LSS-DS,and the two approaches have little influence on the stability of lumbar spine with no significant difference.Direct symptomatic approach can significantly shorten the operation time and reduce the risk of surgery.