The comparison of the effects of UBE and PTED on intervertebral space height and lumbar function in patients with DLSS
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摘要:
目的 对比单侧双通道内镜减压术（UBE）与经皮椎间孔镜术（PTED）治疗退行性腰椎管狭窄症（DLSS）的疗效，为优化微术式选择提供依据。 方法 回顾性纳入2023年5月—2024年12月浙江省台州医院收治的70例DLSS患者，根据术式分为研究组（36例，接受UBE）和对照组（34例，接受PTED），比较2组手术情况、VAS评分、Oswestry功能障碍指数（ODI）评分、椎间隙高度、多裂肌面积与脂肪浸润深度，观察并比较2组并发症发生情况。 结果 研究组手术时间短于对照组，术中出血量少于对照组，而硬膜囊面积增加值与住院费用更高（P＜0.05）；研究组术后1周及1、3、6个月VAS评分均高于对照组（P＜0.05）；研究组术后3、6个月ODI评分均高于对照组（P＜0.05）；研究组术后6个月椎间隙高度高于对照组（P＜0.05）；研究组疗效优良率为91.66%（33/36），高于对照组的73.53%（25/34，P＜0.05）；术后3个月研究组减压侧与对侧多裂肌面积小于对照组，多裂肌脂肪浸润深度大于对照组（P＜0.05）；2组并发症发生率差异无统计学意义[5.56%（2/36）vs. 5.88%（2/34）, P＞0.05]。 结论 UBE治疗DLSS的手术时间短、出血量少，能较好地保留椎间隙高度，减压效果好；PTED疼痛与多裂肌损伤轻、术后腰椎功能恢复好；2种术式安全性均可靠，可依据患者具体解剖条件、病变特点及治疗目标个体化选择术式。 Abstract:Objective To compare the efficacy of unilateral biportal endoscopic (UBE) and percutaneous transforaminal endoscopic discectomy (PTED) in the treatment of degenerative lumbar spinal stenosis (DLSS), and to provide evidence for optimizing the selection of minimally invasive surgical techniques. Methods A total of 70 patients with DLSS from May 2023 to December 2024 treated at Taizhou Hospital of Zhejiang Province were retrospectively included and divided into a study group (n=36, UBE) and a control group (n=34, PTED) according to the surgical methods. The general surgical conditions, VAS scores, Oswestry disability index (ODI) scores, intervertebral space height, multi-fissure muscle area, and depth of fat infiltration were compared between the two groups. Postoperative complications were also observed and compared. Results Compared with the control group, the study group had a shorter operative time, less intraoperative blood loss, a greater increase in dural sac area, and higher hospitalization cost (P < 0.05). The VAS scores in the study group were significantly higher than those in the group at 1 week, 1 month, 3 months, and 6 months after the surgery (P < 0.05). The study group also had higher ODI scores at 3 and 6 months postoperatively (P < 0.05). At 6 months after surgery, intervertebral space height was significantly higher in the study group than in the control group (P < 0.05), and the excellent--good rate was significantly higher [91.66% (33/36) vs. 73.53% (25/34), P < 0.05]. At 3 months postoperatively, the study group had a smaller area of the decompressed-side and contralateral multifidus muscles, as well as a greater depth of fat infiltration in the multifidus muscles, compared with the control group (P < 0.05). There was no significant difference in the incidence of complications between the two groups [5.56% (2/36) vs. 5.88% (2/34), P>0.05]. Conclusion UBE offers advantages in terms of shorter operation time, reduced intraoperative blood loss, better preservation of intervertebral space height, and a superior decompression effect, whereas PTED demonstrates advantages in postoperative pain relief, preservation of the multifidus muscles, and recovery of lumbar function. Both techniques are safe and effective, and the selection of the surgical approach should be individualized based on the specific anatomical conditions, lesion characteristics, and treatment objectives. -
表 1 2组DLSS患者一般资料比较
Table 1. Comparison of general data between the two groups of DLSS patients
组别 例数 性别[例(%)] 年龄(x±s, 岁) BMI (x±s) 症状持续时间(x±s, d) 手术节段[例(%)] 合并慢性病[例(%)] DLSS类型[例(%)] 男性 女性 L2~3 L4~5 L3~4 L5/S1 中央型 侧隐窝型 椎间孔型 研究组 36 13(36.11) 23(63.89) 51.26±5.35 24.93±2.56 20.49±2.18 4(11.11) 18(50.00) 5(13.89) 9(25.00) 19(52.78) 13(36.11) 12(33.33) 11(30.56) 对照组 34 10(29.41) 24(70.59) 52.77±5.29 25.04±2.47 21.04±2.15 5(14.71) 14(41.18) 7(20.59) 8(23.53) 23(67.65) 10(29.42) 12(35.29) 12(35.29) 统计量 0.356a 1.187b 0.183b 1.062b 0.947a 1.611a 0.378a P值 0.551 0.239 0.855 0.292 0.814 0.204 0.828 注：a为χ2值，b为t值。 
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表 2 2组DLSS患者手术一般情况比较(x±s)
Table 2. Comparison of general surgical conditions between the two groups of DLSS patients (x±s)
组别 例数 手术时间(min) 切口长度(cm) 术中出血量(mL) 硬膜囊面积增加值(cm2) 住院时间(d) 住院费用(万元) 研究组 36 73.11±7.59 3.98±0.57 43.26±4.78 57.43±6.08 3.16±0.32 2.34±0.26 对照组 34 116.39±12.67 4.01±0.46 50.11±5.16 45.62±4.67 3.05±0.34 1.37±0.18 t值 17.451 0.241 5.766 9.075 1.394 18.046 P值 ＜0.001 0.810 ＜0.001 ＜0.001 0.167 ＜0.001
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表 3 2组DLSS患者手术前后VAS评分比较(x±s, 分)
Table 3. Comparison of VAS scores before and after surgery between the two groups of DLSS patients (x±s, points)
组别 例数 VAS评分 术前 术后1周 术后1个月 术后3个月 术后6个月 研究组 36 5.61±0.63 2.54±0.28a 1.73±0.18a 1.36±0.17a 1.22±0.15a 对照组 34 5.67±0.58 2.28±0.26a 1.24±0.16a 1.02±0.14a 1.01±0.13a F值 0.414 4.020 12.011 9.104 6.243 P值 0.680 ＜0.001 ＜0.001 ＜0.001 ＜0.001 注：与同组术前比较，aP＜0.05；F交互=58.976，P交互＜0.001；F组间=23.447，P组间＜0.001；F时点=67.134，P时点＜0.001。
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表 4 2组DLSS患者手术前后ODI评分比较(x±s, 分)
Table 4. Comparison of ODI scores before and after surgery between the two groups of DLSS patients (x±s, points)
组别 例数 ODI评分 术前 术后1周 术后1个月 术后3个月 术后6个月 研究组 36 58.26±6.15 32.68±3.67 21.53±2.26a 17.45±2.03a 14.38±1.53a 对照组 34 58.97±5.83 31.38±3.35 20.82±2.13a 12.34±1.44a 12.46±1.27a F值 0.495 1.545 1.351 12.083 5.695 P值 0.622 0.127 1.181 ＜0.001 ＜0.001 注：与同组术前比较，aP＜0.05；F交互=34.122，P交互＜0.001；F组间=13.137，P组间＜0.001；F时点=10.795，P时点＜0.001。
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表 5 2组DLSS患者手术前后椎间隙高度比较(x±s, mm)
Table 5. Comparison of intervertebral space height before and after surgery between the two groups of DLSS patients (x±s, mm)
组别 例数 椎间隙高度 术前 术后1周 术后1个月 术后3个月 术后6个月 研究组 36 12.23±1.29 12.15±1.34 12.02±1.21 11.89±1.19 11.74±1.18 对照组 34 12.10±1.35 11.98±1.45 11.77±1.23 11.34±1.21a 11.01±1.15a F值 0.412 0.510 0.857 1.917 2.619 P值 0.682 0.612 0.394 0.059 0.011 注：与同组术前比较，aP＜0.05；F交互=12.053，P交互＜0.001；F组间=16.775，P组间＜0.001；F时点=4.675，P时点＜0.001。
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表 6 2组DLSS患者手术前后多裂肌损伤情况比较(x±s)
Table 6. Comparison of multifidus muscle injury before and after surgery between the two groups of DLSS patients (x±s)
组别 例数 减压侧多裂肌面积(cm3) 对侧多裂肌面积(cm3) 术前 术后 术前 术后 研究组 36 36.49±3.72 33.48±3.57b 36.29±3.73 33.76±3.68b 对照组 34 36.81±3.69 35.79±3.64b 36.35±3.67 35.71±3.59 统计量 0.361a 8.354c 0.068a 6.154c P值 0.719 0.009 0.946 0.028 组别 例数 减压侧多裂肌脂肪浸润深度(%) 对侧多裂肌脂肪浸润深度(%) 术前 术后 术前 术后 研究组 36 22.98±2.37 29.43±2.96b 23.05±2.38 27.88±2.82b 对照组 34 23.04±2.35 27.26±2.78b 23.10±2.34 25.94±2.63b 统计量 0.106a 6.557c 0.089a 8.762c P值 0.915 0.002 0.929 0.004 注：a为t值，c为F值；与术前比较，bP＜0.05。
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