UBE下腰椎管减压术治疗退变性腰椎管狭窄症的并发症及相关危险因素

Complications and risk factors of Unilateral Biportal Endoscopic Spinal Surgery for Lumbar Spinal Stenosis

目的总结单侧双通道内镜(unilateral biportal endoscopy,UBE)下椎管减压术治疗腰椎管狭窄症(lumbar spinal stenosis,LSS)的并发症并确定相关危险因素。方法回顾性记录并分析2019年1月至2022年1月在该院行UBE下腰椎管减压术的162例单节段LSS患者的并发症。设计病例-对照研究,根据是否存在并发症分为病例组与对照组。人口统计学参数包括年龄、性别、体质量指数、吸烟、饮酒情况、手术时间、伴随疾病情况(高血压、糖尿病、心脑血管疾病)、手术节段、并发症情况。放射学参数包括手术节段椎间盘退变程度、腰椎管狭窄程度、是否存在间盘钙化。单因素分析采用独立样本t检验和卡方检验。结果并发症发生率为9.87%(16/162),其中术后复发1.85%(3/162)、硬膜囊撕裂3.09%(5/162)、硬膜外血肿1.23%(2/162)、减压不充分1.85%(3/162)、术后感染0.62%(1/162)、神经根损伤1.23%(2/162)。单因素分析表明:年龄(P<0.001)、椎管狭窄程度(P<0.05)和椎间盘钙化(P=0.02)与并发症的发生有显著相关性。结论UBE下椎管减压术是一种有效、安全、微创的LSS治疗技术,并发症发生率较低,主要包括复发、硬膜囊撕裂、减压不充分、术后感染、硬膜外血肿、神经根损伤。高龄、严重的椎管狭窄和椎间盘钙化是发生上述并发症的相关危险因素。

Objective To summarize the complications and associated risk factors of unilateral biportal endoscopy(UBE)in the treatment of lumbar spinal stenosis(LSS).Methods The complications of 162 patients with single-level LSS who underwent UBE from January 2019 to January 2022 in our hospital were retrospectively recorded and analyzed.A case-control study was designed and divided into case group and control group according to the existence of complications.Demographic parameters included age,sex,body mass index,smoking and alcohol consumption,duration of surgery,concomitant diseases(such as hypertension,diabetes,cardiovascular and cerebrovascular diseases),surgical stage,and complications.Radiological parameters included the degree of disc degeneration at the operative level,the degree of lumbar stenosis,and the presence or absence of disc calcification.Independent sample t-test and Chi-square test were used for single factor analysis.Results The incidence of different types of complications was 9.87%(16/162).The complications and occurrence rates were as follows:postoperative recurrence was 1.85%(3/162),dural sac tear was 3.09%(5/162),epidural hematoma was 1.23%(2/162),insufficient decompression was 1.85%(3/162),postoperative infection was 0.62%(1/162),nerve root injury was 1.23%(2/162).Univariate analysis showed that age(P<0.001),the degree of spinal canal stenosis(P<0.05)and disc calcification(P=0.02)were significantly correlated with the occurrence of complications.Conclusion Lower spinal canal decompression with UBE is an effective,safe and minimally invasive technique for the treatment of lumbar spinal stenosis.Studies have shown a low incidence of complications,mainly including recurrence,dural sac tear,inadequate decompression,postoperative infection,epidural hematoma,and nerve root injury.Moreover,advanced age,severe spinal stenosis and disc calcification are risk factors for complications.