经椎间孔镜与单侧双通道镜治疗老年腰椎椎管狭窄症

Percutaneous transforaminal endoscopy versus unilateral biportal endoscopy for lumbar spinal stenosis in elderly

[目的]比较经椎间孔内镜(percutaneous transforaminal endoscopy,PTE)与单侧双通道内镜(unilateral biportal endoscopy,UBE)治疗老年退行性腰椎椎管狭窄症(degenerative lumbar spinal stenosis,DLSS)的临床疗效。[方法]回顾性分析2020年1月—2022年6月接受手术治疗的单节段DLSS 72例患者的临床资料。依据医患沟通结果,37例采用PTE术,35例采用UBE术。比较两组围手术期、随访和影像资料。[结果]PTE组手术时间[(63.2±11.0)min vs(81.2±10.3)min,P<0.001]、切口总长度[(1.0±0.2)cm vs(2.5±0.3)cm,P<0.001]、术中失血量[(39.2±10.9)ml vs(89.5±11.3)ml,P<0.001]、下地行走时间[(1.4±0.5)d vs(2.2±0.4)d,P<0.001]、住院时间[(9.2±1.4)d vs(11.2±2.1)d,P<0.001]及完全负重活动时间[(62.2±9.5)d vs(71.1±10.2)d,P<0.001]均显著优于UBE组。随时间推移,两组腰痛VAS、腿痛VAS和ODI评分均显著降低(P<0.05)。术后1 d时PTE组的腰痛VAS评分[(3.7±1.0)vs(4.3±1.1),P=0.018]、腿痛VAS[(2.9±0.5)vs(3.2±0.4),P=0.007]、ODI评分[(26.6±7.7)vs(30.3±5.4),P=0.022]均显著优于UBE组。影像方面,术后两组椎管面积较术前均显著增加(P<0.05),但随时间推移两组椎管面积均再次减少(P<0.05)。末次随访时PTE组椎管面积显著小于UBE组[(126.3±25.4)cm2vs(163.7±28.6)cm2,P<0.001]。相应时间点两组椎间隙高度和腰椎前凸角的差异均无统计意义(P>0.05)。[结论]PTE和UBE两种手术方式治疗DLSS均能取得良好临床疗效,相比UBE,PTE手术创伤小、恢复快,术后早期腰痛、腿痛轻,但UBE减压范围更大。

[Objective]To compare the clinical outcomes of percutaneous transforaminal endoscopy(PTE)versus unilateral biportal en⁃doscopy(UBE)for degenerative lumbar spinal stenosis(DLSS)in the elderly.[Methods]A retrospective research was done on 72 patients who received surgical decompression for single-segment DLSS from January 2020 to June 2022.Based on surgeon-patient discussion pre⁃operatively,37 patients underwent PTE,while other 35 patients received UBE.The perioperative,follow-up and imaging data of the two groups were compared.[Results]The PTE group proved significantly superior to the UBE group in terms of operating time[(63.2±11.0)min vs(81.2±10.3)min,P<0.001],total length of incision[(1.0±0.2)cm vs(2.5±0.3)cm,P<0.001],intraoperative blood loss[(39.2±10.9)ml vs(89.5±11.3)ml,P<0.001],postoperative walk time[(1.4±0.5)days vs(2.2±0.4)days,P<0.001],hospitalization time[(9.2±1.4)days vs(11.2±2.1)days,P<0.001],and time to recover full weight-bearing activity[(62.2±9.5)days vs(71.1±10.2)days,P<0.001].The VASs for lower back pain and leg pain,as well as ODI scores were significantly decreased in both groups over time(P<0.05).The PTE group was signifi⁃cantly better than the UBE group a day postoperatively regarding to VAS score for back pain[(3.7±1.0)vs(4.3±1.1),P=0.018],VAS for leg pain[(2.9±0.5)vs(3.2±0.4),P=0.007],and ODI score[(26.6±7.7)vs(30.3±5.4),P=0.022],despite of that the differences in abovesaid scores between the two groups became not statistically significant since then(P>0.05).With respect of imaging,the canal area in both groups increased significantly postoperatively compared with those preoperatively(P<0.05),but which in both groups decreased again over time after surgery(P<0.05).At the last follow-up,PTE group was significantly inferior to the UBE group in canal aera[(126.3±25.4)cm^(2) vs(163.7±28.6)cm2,P<0.001].There were no statistically significant differences in intervertebral space height and lumbar lordosis between the two groups at any time points accordingly(P>0.05).[Conclusion]Both PTE and UBE can achieve good clinical efficacy in the treat⁃ment of DLSS.By comparison,PTE has benefits of less trauma,faster recovery,and less early postoperative low back pain and leg pain,but UBE get a wider range of decompression.