单侧双通道与单通道脊柱内镜技术辅助双侧减压治疗腰椎管狭窄症的疗效比较

Comparison of curative effects of unilateral double-channel and single-channel spinal endoscopy assisted bilateral decompression in the treatment of lumbar spinal stenosis

中文关键词:  腰椎管狭窄症  单侧椎板切除双侧减压术  单侧双通道脊柱内镜技术

英文关键词:Lumbar spinal stenosis  Unilateral laminectomy and bilateral decompression  Unilateral biportal endoscopy

中文摘要:

  【摘要】 目的：对比单侧双通道脊柱内镜（unilateral biportal endoscopy，UBE）技术与单通道脊柱内镜（percutaneous endoscopy，PE）技术辅助单侧椎板切除双侧减压术（unilateral laminotomy for bilateral decompression，ULBD）治疗腰椎管狭窄症（lumbar spinal stenosis，LSS）的疗效。方法：回顾性分析2023年6月～2024年6月于我院接受ULBD手术治疗的94例LSS患者，依据不同手术辅助技术手段分为对照组（47例，PE-ULBD治疗）与观察组（47例，UBE-ULBD治疗），对比两组围术期指标（手术时间、切口长度、术中出血量、术后卧床及住院时间），影像学评估指标[硬膜囊横截面积（dural sac cross-sectional area，DSCA）、入路侧及入路对侧骨性侧隐窝（lateral recess，LR）减压率、入路侧及入路对侧盘黄间隙减压率、入路侧小关节切除角度]，术前及术后不同时点（术后3d、1个月、6个月）腰部及下肢疼痛视觉模拟量表（visual analog scale，VAS）评分，腰椎功能障碍程度[Oswestry功能障碍指数（Oswestry disability index，ODI）、日本骨科协会（Japanese Orthopaedic Association，JOA）腰椎评分]及炎症反应水平[白细胞介素（interleukin，IL）-4、IL-6、肿瘤坏死因子-α（tumor necrosis factor-α，TNF-α）]，统计两组术后并发症。结果：与对照组相比，观察组手术时间较短，手术切口总长较长（P＜0.05）；两组术中出血量、术后卧床及住院时间相近（P＞0.05）；与对照组相比，观察组术后3d的DSCA、入路侧及入路对侧骨性LR减压率、入路侧及入路对侧盘黄间隙减压率均较高，入路侧小关节切除角度较小（P＜0.05）；与术前相比，两组术后3d、术后1个月、术后6个月腰部疼痛VAS评分及下肢VAS评分均降低，且观察组术后各时点腰部VAS评分及下肢VAS评分均比对照组低（P＜0.05）；与术前相比，两组术后1个月及术后6个月ODI均降低，JOA腰椎评分均提高，且与对照组相比，观察组术后1个月及术后6个月ODI较低，JOA腰椎评分较高（P＜0.05）；与术前相比，两组术后3d IL-4水平均提高，IL-6、TNF-α水平均降低，且与对照组相比，观察组IL-4水平较高，IL-6、TNF-α水平较低（P＜0.05）；观察组术后并发症发生率（4.26%）与对照组（8.51%）相比，差异无统计学意义（P＞0.05）。结论：UBE-ULBD技术和PE-ULBD技术治疗LSS术后并发症均较少，住院时间均较短，PE-ULBD手术切口小，但UBE-ULBD术具有DSCA扩张更大、入路侧小关节保留程度更好、对侧LR及盘黄间隙减压更充分、对周围组织干扰相对较小等优点，可更好减轻患者腰腿疼痛及机体炎症反应，改善腰椎功能。

英文摘要:

  【Abstract】 Objectives: To compare the efficacies of unilateral biportal endoscopy(UBE) and percutaneous endoscopy(PE) assisted unilateral laminotomy for bilateral decompression(ULBD) in the treatment of lumbar spinal stenosis(LSS). Methods: The clinical data of 94 patients with LSS who underwent ULBD surgery in our hospital between June 2023 and June 2024 were retrospectively analyzed. The patients were divided into a control group(47 cases, PE-ULBD) and an observation group(47 cases, UBE-ULBD) according to different surgical auxiliary techniques. The perioperative indicators(including operative time, incision length, intraoperative blood loss, and bed rest and hospitalization time), imaging evaluation indexes[including the dural sac cross-sectional area(DSCA), decompression rate of approach side and contralateral side bony lateral recess(LR), decompression rate of ipsilateral and contralateral disc space, and resection angle of facet joint in the approach side], as well as low back pain and leg pain visual analogue scale(VAS) scores, Oswestry disability index(ODI), Japanese Orthopaedic Association(JOA) score, and the level of inflammatory reaction[interleukin-4(IL-4), IL-6, tumor necrosis factor-α(TNF-α)] before and after operation(3d, 1 month, 6 months) were compared between the two groups. The postoperative complications of the two groups were counted. Results: Compared with the control group, the operative time in the observation group was shorter and the total length of the incision was longer(P<0.05). The amount of blood loss, postoperative bed rest and hospitalization time in the two groups were similar(P>0.05). Compared with the control group, the DSCA, decompression rate of LR, decompression rate of ipsilateral and contralateral disc space in the observation group were higher on the 3rd postoperative day, and the resection angle of facet joint in the approach side was smaller(P<0.05). The low back pain and leg pain VAS scores in both groups decreased at postoperative 3d, 1 month and 6 months compared with preoperative values, and the observation group was lower than the control group at each postoperative time point(P<0.05). ODIs in both groups decreased at postoperative 1 month and 6 months compared with preoperative values, while JOA scores increased. Compared with the control group, the ODI in the observation group was lower at 1 month and 6 months after operation, and JOA score was higher(P<0.05). The levels of IL-4 in both groups at postoperative 3d were increased compared with before operation, and the levels of IL-6 and TNF-α were decreased(P<0.05). Compared with the control group, the levels of IL-4 in the observation group were higher, but the levels of IL-6 and TNF-α were lower(P<0.05). The incidence of postoperative complications in the observation group(4.26%) was not statistically significantly different compared with that in the control group(8.51%, P>0.05). Conclusions: Both UBE-ULBD and PE-ULBD techniques result in fewer postoperative complications and shorter hospitalization time in the treatment of LSS. PE-ULBD has a small surgical incision. However, UBE-ULBD offers superior benefits such as greater expansion of the DSCA, better preservation of facet joints on the approach side, more adequate decompression of the contralateral LR and disc-space, and relatively less interference to surrounding tissues. It can more effectively alleviate lumbocrural pain and systemic inflammatory response in patients, as well as improve lumbar spine function.