内镜下交叉过顶减压与单侧入路双侧减压治疗重度腰椎管狭窄症的临床疗效对比分析

Comparative analysis of clinical efficacy between endoscopic cross-overtop decompression and endoscopic unilateral laminotomy for bilateral decompression in the treatment of severe lumbar spinal stenosis

中文关键词:  脊柱内镜  交叉过顶技术  重度腰椎管狭窄症  微创手术  单侧入路双侧减压

英文关键词:Spinal endoscopy  Cross-overtop decompression technique  Severe lumbar spinal stenosis  Minimally invasive surgery  Endoscopic unilateral laminotomy and bilateral decompression(Endo-ULBD)

中文摘要:

  【摘要】 目的：探讨内镜下交叉过顶减压（cross-overtop decompression，Cross-overtop）与单侧入路双侧减压（endoscopic unilateral laminotomy bilateral decompression，Endo-ULBD）治疗重度腰椎管狭窄症的临床疗效。方法：回顾性分析自2021年7月~2022年12月于我科住院的单节段重度腰椎管狭窄症病例，采用Cross-overtop减压或Endo-ULBD减压，每组各30例患者；男37例，女23例，Cross-overtop组年龄66.2±8.8岁，Endo-ULBD组年龄71.4±8.7岁。对所有患者行术后1周、3个月、6个月及不少于12个月末次随访。采用视觉模拟评分（visual analog scale，VAS），腰椎Oswestry功能障碍指数（Oswestry disability index，ODI）及日本骨科协会（Japanese Orthopaedic Association，JOA）评分进行术后疗效评价；测量责任节段椎管矢状径评价术后中央椎管扩大程度，末次随访时采用MacNab量表评价术后优良率。结果：60例患者均获得完整随访数据，随访时间12~25个月；两组患者各随访时间点腰腿痛VAS评分及腰椎ODI评分均较前次随访改善，Cross-overtop组术后责任节段中央椎管矢状径扩大率（5.08％）大于Endo-ULBD组（1.59％），差异均有统计学意义（P＜0.05）。两组患者末次随访时进行MacNab评估，其中Cross-overtop组优良率90.0%，Endo-ULBD组优良率83%。结论：Cross-overtop减压是治疗重度腰椎管狭窄症微创脊柱内镜手术方法之一，其安全有效，优势明显。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical efficacies of endoscopic cross-overtop decompression(Cross-overtop) and endoscopic unilateral laminotomy bilateral decompression(Endo-ULBD) in the treatment of severe lumbar spinal stenosis. Methods: A retrospective study was conducted on the patients with single-level severe lumbar spinal stenosis admitted and treated with Cross-overtop decompression(30 cases) and Endo-ULBD(30 cases) in our hospital between July 2021 and December 2022. There were 37 male cases and 23 female cases. The average age of the Cross-overtop group was 66.2±8.8 years, and the average age of the Endo-ULBD group was 71.4±8.7 years. The patients were followed up at 1 week, 3 months, 6 months, and ≥12 months(final) after operation. Clinical outcomes were assessed using the visual analog scale(VAS) score, Oswestry disability index(ODI), and Japanese Orthopaedic Association(JOA) scores. The sagittal diameter of the affected spinal canal was measured to evaluate central canal expansion. Postoperative excellent and good rate of efficacy were determined using the MacNab criteria at 12 months′ or the final follow-up. Results: All 60 patients completed follow-up with a duration ranging from 12 to 25 months. Both groups showed significant improvements in VAS scores for low back and leg pain and ODI at each follow-up interval compared to the previous assessment. The Cross-overtop group demonstrated a greater expansion rate(5.08%) of the sagittal diameter of the central canal at the affected level compared to the Endo-ULBD group(1.59%), with statistically significant differences(P<0.05). At postoperative 12-month or final follow-up, MacNab evaluation revealed an excellent and good rate of 90.0% in the Cross-overtop group and 83% in the Endo-ULBD group. Conclusions: Cross-overtop decompression is one of the minimally invasive endoscopic surgical techniques for treating severe lumbar spinal stenosis, which is safe and effective with distinct advantages.