单侧双通道内镜与单通道内镜下减压治疗腰椎管狭窄症的疗效比较研究

Comparison of effectiveness between unilateral biportal endoscopic and uniportalinterlaminar endoscopic depression in treatment of lumbar spinal stenosis

目的 比较单侧双通道内镜(unilateral biportal endoscopy,UBE)技术与单通道内镜(uniportal interlaminar endoscopy,UIE)技术行单侧入路双侧椎管减压术(unilateral laminotomy and bilateral decompression,ULBD)治疗腰椎管狭窄症的疗效。方法 回顾分析2021年3月—2022年11月收治且符合选择标准的52例腰椎管狭窄症患者临床资料,其中采用UBE技术行ULBD 23例(UBE组)、UIE技术29例(UIE组)。两组患者年龄、性别构成、身体质量指数、手术节段构成、腰椎狭窄类型以及术前腰痛疼痛视觉模拟评分(VAS)、腿痛VAS评分、Oswestry功能障碍指数(ODI)、椎间盘高度、硬膜囊面积等基线资料比较,差异均无统计学意义(P>0.05)。比较两组患者围术期指标(手术时间、切口长度、住院时间、手术并发症情况)、临床指标(术前以及术后3 d及1、6、12个月腰腿痛VAS评分、ODI)和影像学指标(术前及术后1、12个月椎间盘高度、硬膜囊面积,硬膜囊扩张面积)。结果 两组均顺利完成手术。与UIE组相比,UBE组手术时间缩短、切口长度延长(P<0.05),但两组住院时间及并发症发生率比较差异无统计学意义(P>0.05)。术后患者均获随访,随访时间12~20个月,平均14个月。术后各时间点腰、腿痛VAS评分及ODI均较术前改善(P<0.05),上述指标术后各时间点间比较差异均无统计学意义(P>0.05);术后各时间点两组间比较,差异均无统计学意义(P>0.05)。影像学复查示,术后各时间点两组间椎间盘高度比较,差异均无统计学意义(P>0.05);但UBE组硬膜囊面积及硬膜囊扩张面积均优于UIE组,差异有统计学意义(P<0.05)。结论 采用UBE技术和UIE技术行ULBD治疗腰椎管狭窄症均能获得满意疗效,但前者减压更彻底,硬膜囊扩张面积优于后者。

Objective To compare effectiveness between unilateral laminotomy and bilateral decompression(ULBD)with unilateral biportal endoscopy(UBE)and uniportal interlaminar endoscopy(UIE)in the treatment of lumbar spinal stenosis.Methods A clinical data of 52 patients with lumbar spinal stenosis,who met the inclusion criteria and treated with ULBD between March 2021 and November 2022,was retrospectively analyzed.The patients were allocated into UBE group(23 cases)and UIE group(29 cases)according to the surgical methods.There was no significant difference(P>0.05)in age,gender,body mass index,surgical segment,type of lumbar stenosis,and preoperative visual analogue scale(VAS)scores of lower back pain and leg pain,Oswestry disability index(ODI),disc height,and dural sac area between the two groups.Perioperative indexes(incision length,operation time,hospital stay,and surgical complications),clinical indicators(VAS scores of lower back pain and leg pain and ODI before operation and at 3 days,1 month,6 months,and 12 months after operation),and imaging indicators(disc height and dural sac area before operation and at 1,12 months after operation,and dural sac expansion area)were recorded and compared between the two group.Results All operations in both groups were successfully completed. Compared with the UIE group, the UBE group hadshorter operation time and longer incision length, with statistically differences (P<0.05). But there was no significantdifference in hospital stay and incidence of complications between the two groups (P>0.05). All patients were followed upfor 12-20 months (mean, 14 months). The VAS scores of lower back pain and leg pain and ODI after operationsignificantly improved compared to preoperative values (P<0.05), and there was no significant difference in the aboveindicators between different time points after operation (P>0.05). There was no significant difference between the twogroups at dofferent time points between the two groups (P>0.05). Imaging examination showed that there was nosignificant difference in disc height between the two groups at different time points after operation (P>0.05). However, thedural sac area and dural sac expansion area were significantly larger in the UBE group than in the UIE group (P<0.05).Conclusion ULBD with UBE and UIE can achieve satisfactory effectiveness in the treatment of lumbar spinal stenosis.But the former has more thorough decompression and better dural sac expansion than the latter.