单轴PLUS内镜ULBD技术治疗腰椎管狭窄症伴无临床不稳的Ⅰ°滑脱的疗效分析

Clinical effect of lumbar spinal stenosis withⅠ°spondylolisthesis without clinical instability by uniaxial PLUS endoscopic ULBD technique

目的评价单轴PLUS内镜单侧椎板切开双侧减压(ULBD)技术治疗腰椎管狭窄症伴无临床不稳的Ⅰ°滑脱的疗效。方法回顾性分析2019年5月—2022年5月山西省人民医院收治的21例接受单轴PLUS内镜通过后路ULBD技术治疗腰椎管狭窄症伴无临床不稳的Ⅰ°滑脱患者的临床资料,其中男性10例,女性11例;平均年龄(69.00±3.62)岁,年龄范围65~81岁。评估术前以及术后3、6、12个月的疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)和跛行距离。术后12个月采用MacNab评分对患者总体临床疗效进行评估。通过腰椎动力位片评估患者术前和术后3个月腰椎的稳定性。计量资料以均数±标准差(x±s)表示,手术前后比较采用t检验,不同时间点比较采用单因素重复测量方差分析。结果MacNab评分结果显示,术后效果优57.1%(12/21),良28.6%(6/21),可9.5%(2/21),差4.8%(1/21),总体优良率为85.7%(18/21)。术后3、6、12个月疼痛VAS评分、ODI及跛行距离同术前比较均有明显改善,差异均有统计学意义(P<0.01)。术前及术后腰椎动力位片评估无明显稳定性改变。结论单轴PLUS内镜ULBD技术在治疗腰椎管狭窄症伴无临床不稳的Ⅰ°滑脱临床疗效改善明显,术后无明显稳定性改变,可以达到较好的临床效果。

Objective To evaluate the efficacy of uniaxial PLUS endoscopic unilateral laminotomy for bilateral decompression(ULBD)technique in the treatment of lumbar spinal stenosis withⅠ°spondylolisthesis without clinical instability.Methods A retrospective case analysis method was used to analyze the clinical data of 21 patients with lumbar spinal stenosis withⅠ°spondylolisthesis without clinical instability treated by uniaxial PLUS endoscopy via posterior ULBD technique in Shanxi Provincial People′s Hospital from May 2019 to May 2022.There were 10 males and 11 females,aged from 65 to 81 years,the average age was(69.00±3.62)years.The visual analogue scale(VAS),Oswestry disability index(ODI)and limp distance were evaluated before operation and at 3,6 and 12 months after operation.The overall clinical efficacy was evaluated by MacNab score at 12 months after operation.Lumbar dynamic radiography was used to evaluate the stability of the lumbar spine before operation and at 3 months after operation.Measurement data were expressed as mean±standard deviation(x±s),t-test was used for comparison before and after operation,and one-way repeated measures analysis of variance was used for comparison at different time points.Results According to MacNab score,the results were excellent in 12 cases(57.1%),good in 6 cases(28.6%),fair in 2 cases(9.5%)and poor in 1 case(4.8%),the overall excellent and good rate was 85.7%(18/21).The VAS,ODI and limp distance at 3,6 and 12 months after operation were significantly improved compared with those before operation,the differences were statistically significant(P<0.01).There was no significant change in the stability of the lumbar spine dynamic position before and after operation.Conclusion Uniaxial PLUS endoscopic ULBD technique can significantly improve the clinical efficacy in the treatment of lumbar spinal stenosis withⅠ°spondylolisthesis without clinical instability,and there is no significant change in stability after operation,and good clinical results can be achieved.