单侧双通道脊柱内镜下单侧椎板切除双侧减压技术治疗腰椎管狭窄症的并发症特征及影响因素

Characteristics of complications and impact factors of unilateral biportal endoscopy-unilateral laminectomy for bilateral decompression technique in the treatment of lumbar spinal stenosis

目的分析采用单侧双通道脊柱内镜下单侧椎板切除双侧减压技术(UBE-ULBD)进行手术治疗的腰椎管狭窄症患者的围手术期资料,探讨围手术期并发症的发生情况、临床特征和影响因素。方法回顾性分析2021年6月—2023年6月于首都医科大学附属北京友谊医院骨科接受UBE-ULBD手术治疗的77例腰椎管狭窄症患者的临床资料,其中男性28例,女性49例,平均年龄(67.61±15.29)岁。收集患者的基线资料、手术相关信息以及围手术期及随访期内并发症和主观评分变化。采用Kolmogorov-Smirnov检验对连续性变量进行正态性检验。正态分布的连续性变量以均数±标准差(±s)表示,组间比较采用Student-t检验或重复测量资料方差分析;非正态分布的连续性变量以中位数(四分位间距)[M(Q_(1),Q_(3))]表示,组间比较采用非参数检验。分类变量以例数和百分比[例(%)]表示,组间比较采用χ^(2)检验。采用单因素分析对变量进行评价,将单因素分析结果中差异具有统计学意义的指标进一步纳入多因素Logistic回归分析,进一步明确并发症发生的独立危险因素。结果根据术后并发症发生情况,将患者分为未发生并发症组(n=73)和并发症组(n=4)。并发症组包括硬膜撕裂2例、术后残留症状1例和术后硬膜外血肿1例。与术前相比,术后第1天患者的Oswestry功能障碍指数(ODI)评分、腰痛及腿痛视觉模拟评分(VAS)均有所改善,差异均具有统计学意义(P<0.01);与术后第1天相比,除ODI评分以外,术后第3个月时腰痛及腿痛VAS评分均有所改善,差异均具有统计学意义(P<0.01)。两组患者的术中出血量和手术时间比较,差异均具有统计学意义(P<0.05)。将单因素分析中差异具有统计学意义的变量纳入多因素Logistic回归分析,结果表明,手术时间延长是患者发生围手术期并发症的独立危险因素(OR=1.031,95%CI:1.000~1.054,P=0.030)。结论作为一种治疗腰椎管狭窄症的有效的微创脊柱内镜技术,UBE-ULBD技术具有较低的并发症发生率和较快的术后康复等优点。术者提高手术熟练度、适当缩短手术时间有助于降低硬膜撕裂等并发症发生率。

ObjectiveTo analyze the perioperative data of patients with lumbar spinal stenosis who were surgically treated by unilateral biportal endoscopy-unilateral laminectomy for bilateral decompression(UBE-ULBD)technique,and to explore the occurrence,clinical features,and influencing factors for perioperative complications.MethodsA retrospective analysis of the clinical data of 77 patients with lumbar spinal stenosis who underwent UBE-ULBD surgery in the Department of Orthopedics,Beijing Friendship Hospital,Capital Medical University from June 2021 to June 2023 was performed,of which 28 were males and 49 were females,with a mean age of(67.61±15.29)years.The baseline data,surgery-related information,and complications and subjective scores during the perioperative and follow-up periods of the patients were collected.Continuous variables were tested for normality using the Kolmogorov-Smirnov test.Normally distributed continuous variables were expressed as mean±standard deviation(±s),and the Student-t test and analysis of variance for repeated measures information were used for comparison between groups;non-normally distributed continuous variables were expressed as median(interquartile distance)[M(Q 1,Q 3)],and and non-parametric tests were used for comparison between groups.Categorical variables were expressed as number of cases and percentage,and the Chi-square test was used for comparison between groups.Variables were analyzed using univariate analysis,and indicators with statistically significant differences in the results of univariate analysis were further included in multivariate Logistic regression analysis to further clarify the independent risk factors for the occurrence of complications.ResultsAccording to the occurrence of postoperative complications,the patients were divided into the non-complication group(n=73)and the complication group(n=4).The complication group included 2 cases of dural tear,1 case of postoperative residual symptoms,and 1 case of postoperative epidural hematoma.Compared with the preoperative results,the Oswestry disability index(ODI)score and visual analogue score(VAS)for low back pain and leg pain on the first day after surgery were improved,and the differences were statistically significant(P<0.01).Compared with the first day after surgery,except for the ODI scores,the VAS scores for low back pain and leg pain were improved at the third month after surgery,and the differences were statistically significant(P<0.01).The differences in intraoperative blood loss and operative time between the two groups were statistically significant(P<0.05).The variables with statistically significant differences in univariate analysis were included in the multivariate Logistic regression analysis,and the results indicated that prolonged operative time was an independent risk factor for perioperative complications in patients(OR=1.031,95%CI:1.000-1.054,P=0.030).ConclusionsAs an effective minimally invasive spinal endoscopic technique for the treatment of lumbar spinal stenosis,the UBE-ULBD technique has the advantages of lower complication rates and faster postoperative recovery.Improvement of surgical proficiency by the operator and appropriate shortening of operative time can help to reduce the incidence of complications such as dural tear.