单侧双通道内镜下融合治疗在单节段腰椎侧隐窝狭窄症中的应用研究

Study on the application of unilateral biportal endoscopic fusion treatment in single-segment lumbar lateral recess stenosis

目的对比分析大通道脊柱内镜和单侧双通道内镜(UBE)下融合治疗单节段腰椎侧隐窝狭窄症的效果。方法回顾性分析安康市人民医院2021年1月至2023年1月收治的85例单节段腰椎侧隐窝狭窄症患者的临床资料。根据治疗方法不同分为两组,大通道组44例中男23例,女21例,年龄(65.88±7.35)岁,病程(3.42±0.68)年,接受大通道脊柱内镜减压手术;UBE组41例中男19例,女22例,年龄(65.51±7.26)岁,病程(3.51±0.74)年,接受UBE下腰椎融合术。比较两组患者围手术期指标,比较两组患者术前、术后1 d、术后5 d的腰部和下肢疼痛情况[视觉模拟评分法(VAS)评分],比较两组术前和术后7 d侧隐窝恢复情况,并采用日本骨科协会(JOA)评分、Oswestry功能障碍指数(ODI)和日常活动能力量表(ADL)比较两组患者术前、术后1个月、术后6个月的腰椎功能和活动能力,记录患者并发症发生情况。采用χ^(2)检验、t检验、方差分析。结果UBE组手术时间、术中出血量、切口长度、住院时间分别为(65.14±4.39)min、(17.02±2.32)ml、(2.02±0.31)cm、(6.18±0.73)d,大通道组分别为(71.92±5.42)min、(20.68±2.51)ml、(2.34±0.35)cm、(7.35±0.79)d,差异均有统计学意(t=6.309、6.967、4.449、7.077,均P<0.001)。术后1 d和5 d,UBE组的腰、腿部VAS评分均低于大通道组(均P<0.05)。术后7 d,UBE组的软性、骨性侧隐窝角度分别为(31.40±4.19)°、(35.41±4.06)°,大通道组分别为(26.84±3.26)°、(28.12±3.31)°,差异均有统计学意义(t=5.621、9.034,均P<0.001)。术后1个月,UBE组的JOA、ADL评分均高于大通道组,ODI评分低于大通道组,差异均有统计学意义(均P<0.05);术后6个月,两组JOA、ADL、ODI评分比较,差异均无统计学意义(均P>0.05)。UBE组并发症总发生率为7.32%(3/41),大通道组为11.36%(5/44),差异无统计学意义(χ^(2)=0.408,P=0.523)。结论UBE技术具有创伤更小、恢复更快的优势,能降低单节段腰椎侧隐窝狭窄症患者术后疼痛,加快腰椎功能恢复进程,但两种技术的长期恢复效果无显著差异。

Objective To compare and analyze the effects of large-channel spinal endoscopic decompression surgery and unilateral biportal endoscopy(UBE)lumbar fusion surgery in the treatment of single-segment lumbar lateral recess stenosis.Methods The clinical data of 85 patients with single-segment lumbar lateral recess stenosis admitted to Ankang People's Hospital from January 2021 to January 2023 were retrospectively analyzed.All patients were divided into two groups according to different treatment methods.In the large channel group,there were 23 males and 21 females,aged(65.88±7.35)years,with duration of disease of(3.42±0.68)years,who underwent large-channel spinal endoscopic decompression surgery.In the UBE group,there were 19 males and 22 females,aged(65.51±7.26)years,with duration of disease of(3.51±0.74)years,who underwent UBE lumbar fusion surgery.The perioperative indicators of the two groups were compared,the discomfort levels of the waist and lower extremities of the two groups were compared before,1 day,and 5 days after surgery,and the recovery of the lateral recess before and 7 days after surgery were compared between the two groups.The Japanese Orthopaedic Association(JOA)score,Oswestry Disability Index(ODI),and Activities of Daily Living Scale(ADL)were used to compare the lumbar function and activity abilities of the two groups before,1 month,and 6 months after surgery.The complications were also recorded.χ^(2)test,t test,and analysis of variance were used.Results The operation time,intraoperative blood loss,incision length,and hospital stay in the UBE group were(65.14±4.39)min,(17.02±2.32)ml,(2.02±0.31)cm,and(6.18±0.73)d,which were lower than those in the large channel group(t=6.309,6.967,4.449,and 7.077,all P<0.001).The pain scores of the waist and lower extremities in the UBE group 1 d and 5 d after surgery were lower than those in the large channel group,with statistically significant differences(all P<0.05).The angles of soft lateral recess and bone lateral recess in the UBE group were(31.40±4.19)°and(35.41±4.06)°,which were higher than those in the large channel group[(26.84±3.26)°and(28.12±3.31)°],with statistically significant differences(t=5.621 and 9.034,both P<0.001).One month after surgery,the JOA score and ADL score in the UBE group were higher than those in the large channel group,and the ODI was lower than that in the large channel group,with statistically significant differences(all P<0.05).Six months after surgery,there was no statistically significant difference in the JOA score,ADL score,or ODI between the two groups(all P>0.05).The complication rate was 7.32%(3/41)in the UBE group and 11.36%(5/44)in the large channel group,with no statistically significant difference(χ^(2)=0.408,P=0.523).Conclusions UBE technology offers advantages of minimal trauma and faster recovery,reducing postoperative pain and accelerating the recovery process of lumbar function in patients with single-segment lumbar lateral recess stenosis.However,there is no significant difference in the long-term recovery effects between the two techniques.