单侧双通道内镜下减压治疗腰椎管狭窄症的早期疗效观察

Preliminary clinical outcomes of unilateral biportal endoscopy for decompressing lumbar spinal stenosis

中文关键词:  腰椎管狭窄症  双通道  内镜手术  早期疗效

英文关键词:Lumbar spinal stenosis  Biportal  Endoscopic surgery  Preliminary follow-up

中文摘要:

  【摘要】 目的：观察单侧双通道内镜下进行单侧椎板切除双侧减压治疗腰椎管狭窄症的早期临床疗效。方法：回顾性分析我院2020年4月1日~2021年1月31日应用单侧双通道内镜技术进行单侧椎板切除双侧减压治疗单节段腰椎管狭窄症且随访3个月以上患者的临床及影像学资料。共纳入64例单节段腰椎管狭窄症患者，其中中央椎管狭窄患者28例，男15例，女13例，年龄57~77岁（67.79±6.29岁），体质指数（BMI）为22.31±2.89kg/m2；随访3~9个月（3.86±1.80个月）；双侧侧隐窝狭窄36例，男17例，女19例，年龄50~79岁（62.75±8.02岁），BMI 23.14±2.73kg/m2，随访3~9个月（4.83±2.30个月）。中央椎管狭窄组患者术前病变节段Schizas分级B级14例，C级13例，D级1例；侧隐窝狭窄组患者术前A级8例，B级17例，C级11例。统计所有患者术前与术后次日、1个月、3个月及末次随访时的腰腿痛视觉模拟评分（visual analogue scales，VAS）和Oswestry功能障碍指数（Oswestry disability index，ODI），手术前后的硬脊膜囊截面积、血常规血红蛋白量，手术时间、术后下地时间和出院时间。通过配对样本t检验对比分析手术减压前后临床评分结果。结果：两组患者术后次日、1个月、3个月及末次随访时的腰痛和腿痛VAS评分均明显小于术前（P<0.05）；两组患者术后1个月、3个月及末次随访ODI均明显小于术前（P<0.05）。中央椎管狭窄组和侧隐窝狭窄组患者术后血红蛋白分别下降21.54±7.24g/L和21.00±7.67g/L，手术时间分别为120.75±9.79min和106.40±12.99min，术后下地时间分别为1.61±0.63d和1.47±0.61d，术后住院时间分别为4.39±1.77d和3.69±1.70d，硬脊膜囊截面积改善率分别为（108.21±38.28）%和（62.20±53.10）%。中央椎管狭窄组术后病变节段Schizas分级均恢复至A级；侧隐窝狭窄组1例患者由术前C级恢复至B级，其余35例均恢复至A级。两组患者术中均未更改手术方式，术后均未出现严重并发症，均未行二次手术。结论：单侧双通道内镜下单侧椎板切除双侧减压技术对腰椎管狭窄症患者的腰椎中央椎管狭窄和双侧侧隐窝狭窄能够实现充分的减压，早期随访临床效果确切，且安全性亦较高。

英文摘要:

  【Abstract】 Objectives: To evaluate the preliminary clinical outcomes of unilateral biportal endoscopy(UBE) unilateral laminectomy bilateral decompression(ULBD) for lumbar spinal stenosis. Methods： The data of patients with single-level central spinal stenosis or lateral recess stenosis who underwent UBE ULBD in our department from April 2020 till January 2021 and were followed up over three months were analyzed retrospectively. A total of 64 patients were included in our study, of which there were 28 with central lumbar spinal stenosis[15 males and 13 females; 57-77 years old, averaged 67.79±6.29 years; mean body mass index(BMI) 22.31±2.89kg/m2; follow-up duration 3-9 months, averaged 3.86±1.80 months] and 36 with lateral recess stenosis(17 males and 19 females; 50-79 years old, averaged 62.75±8.02 years; mean BMI 23.14±2.73kg/m2; follow-up duration 3-9 months, averaged 4.83±2.30 months). There were 14 cases of Schizas level B, 13 of level C and 1 of level D in the central lumbar spinal stenosis group, while 8 of level A, 17 of level B and 11 of level C in the lateral recess stenosis group. The visual analogue scales (VAS) for pain in back and legs, and the Oswestry disability index (ODI) of all the patients were collected before operation, on the second day after operation, at one-month, three-month and the last follow-ups. Moreover, the preoperative and postoperative area of dural sac, hemoglobin, operation time, ambulation time, and hospitalization period were recorded. Paired t-test was applied to compare the differences between preoperative and postoperative values, as well as during the follow-ups. Results: The VAS scores for back and leg pain on the next day after operation, at one-month, three-month and the last follow-up of both groups were significantly lower than those preoperatively. The ODI scores at one-month, three-month and last follow-up of both groups were significantly lower than those preoperatively. Of the central lumbar spinal stenosis group and the lateral recess stenosis group, the postoperative hemoglobin decreased by 21.54±7.24g/L and 21.00±7.67g/L, the operation time was 120.75±9.79min and 106.40±12.99min, the ambulation time was 1.61±0.63 and 1.47±0.61 days, and the hospitalization period were 4.39±1.77 and 3.69±1.70 days, respectively. The improvement rates of dural sac area of the two groups were (108.21±38.28)% and (62.20±53.10)% respectively. All central lumbar spinal stenosis cases improved to Schizas level A. 1 case in lateral recess stenosis group improved from level C to B, and all other cases improved to level A. There were no severe complications or adverse events happened. Conclusions: The UBE ULBD is an effective and safety surgery for sufficient decompression of lumbar spinal stenosis or lateral recess stenosis with certain early follow-up′s outcomes.