单侧双通道内镜技术治疗不同Manjila分型腰椎硬膜外脂肪增多症的早期临床疗效

Clinical efficacy of unilateral biportal endoscopy in the treatment of lumbar epidural lipomatosis of different Manjila classifications

中文关键词:  腰椎硬膜外脂肪增多症  单侧双通道内镜  Manjila分型  微创减压  椎管狭窄

英文关键词:Lumbar epidural lipomatosis  Unilateral biportal endoscopy  Manjila classification  Minimally invasive decompression  Spinal stenosis

中文摘要:

  【摘要】 目的：评估单侧双通道脊柱内镜技术（unilateral biportal endoscopy，UBE）治疗不同Manjila分型腰椎硬膜外脂肪增多症（lumbar epidural lipomatosis，LEL）的早期临床疗效。方法：回顾性分析2022年6月~2024年6月在我院采用UBE手术治疗并获得随访的16例LEL患者的临床资料，其中男9例，女7例，年龄56.3±13.5岁；所有患者术前均有神经根受压症状（腰痛、下肢放射痛及间歇性跛行）。依据术前腰椎MRI检查结果，明确椎管狭窄的具体部位与范围，采用3×3网格法评估狭窄程度，并进行Manjila分型以明确脂肪压迫的主体方位，从而指导手术策略。记录手术时间、总出血量、住院时间及并发症；采用视觉模拟量表（visual analogue scale，VAS）评分、日本骨科协会（Japanese Orthopaedic Association，JOA）评分及Oswestry功能障碍指数（Oswestry disability index，ODI）分别评估术前、术后3d、1个月及末次随访时的腰腿痛程度和神经功能状态；末次随访时采用改良MacNab标准评价总体疗效。术前及术后6个月影像学上通过测量椎管横截面积（cross-sectional area of the spinal canal，CSA-SC）客观评估椎管容积变化。结果：本研究16例患者的Manjila分型结果为Ⅰ型6例（中度4例、重度2例），Ⅱ型7例（中度4例、重度3例），Ⅲ型3例（中度2例、重度1例）。所有患者手术均顺利完成，无中转开放，围手术期未发生严重并发症。手术时间80.38±12.13min，总出血量52.81±26.39mL，住院时间4.50±1.32d。随访13.41±1.38个月，术后腰腿痛VAS评分、ODI显著下降，JOA评分显著提升（P<0.05），至末次随访时，三型患者的临床评分均改善至相同优良水平。三型患者术后末次随访时MacNab优良率达87.5%，同时术后6个月腰椎MRI上CSA-SC较术前均显著增加（P<0.05），其中Ⅱ型与Ⅲ型患者的CSA-SC改善率高于Ⅰ型。1例Ⅱ型（重度）患者术后症状复发，经保守治疗后缓解。结论：UBE能精准、微创地完成LEL患者的减压手术，基于Manjila分型实施个体化入路调整及椎管减压，对各型LEL患者均显示出良好的早期疗效。

英文摘要:

  【Abstract】 Objectives: To investigate the early clinical efficacy of unilateral biportal endoscopy(UBE) in the treatment of lumbar epidural lipomatosis(LEL) based on the Manjila classification. Methods: A retrospective analysis was conducted on the clinical data of 16 patients with LEL who underwent UBE surgery in our hospital between June 2022 and June 2024. There were 9 males and 7 females, with an average age of 56.3±13.5 years. All patients presented with preoperative symptoms of nerve root compression, including low back pain, lower limb radiating pain, and intermittent claudication. Based on preoperative lumbar MRI findings, the specific location and extent of spinal canal stenosis were identified. The 3×3 grid method was used to assess the degree of stenosis, and the Manjila classification was applied to determine the predominant direction of fat compression, thereby guiding surgical strategy. Operative time, estimated blood loss, hospital stay, and complications were recorded. The visual analogue scale(VAS) and, Japanese Orthopaedic Association(JOA) Scores, as well as Oswestry disability index(ODI) were used to assess the degree of low back and leg pain and neurological function preoperatively, at postoperative 3d, 1 month, and final follow-up. The modified MacNab criteria were used to evaluate the overall efficacy at final follow-up. Changes in spinal canal volume were assessed by measuring the preoperative and postoperative 6-month cross-sectional area of the spinal canal(CSA-SC) on imaging. Results: The Manjila classification results were: type Ⅰ in 6 cases(moderate 4, severe 2), type Ⅱ in 7 cases(moderate 4, severe 3), and type Ⅲ in 3 cases(moderate 2, severe 1). All surgeries were successfully completed without conversion to open surgery, and no serious perioperative complications occurred. The mean operative time was 80.38±12.43min, the mean estimated blood loss was 52.81±26.39mL, and the mean postoperative hospital stay was 4.50±1.32d. The patients were followed up for 13.41±1.38 months. Postoperative VAS scores for low back and leg pain and ODI decreased significantly, while JOA scores increased significantly(P<0.05). At final follow-up, clinical scores had improved to a similarly favorable level across all three types of patients. The excellent and good rate according to the modified MacNab criteria was 87.5% for all three types of patients. Furthermore, lumbar MRI at the 6-month follow-up showed a significant increase in the CSA-SC in all patients compared to preoperative values(P<0.05), with patients in type Ⅱ and type Ⅲ showed higher improvement rates in CSA-SC than those in type Ⅰ. Symptom recurrence occurred in one patient with severe type Ⅱ LEL, which was relieved after conservative treatment. Conclusions: The UBE technique enables precise and minimally invasive decompression for LEL patients. Individualized surgical approach adjustments and spinal canal decompression based on the Manjila classification demonstrates favorable early efficacy for all types of LEL patients.