单侧双通道内镜治疗单责任节段腰椎管狭窄症的短期临床疗效分析

芦怀旺; 田霖; 胡鹏; 刘彬; 张玉红

doi:10.16766/j.cnki.issn.1674-4152.002896

单侧双通道内镜治疗单责任节段腰椎管狭窄症的短期临床疗效分析

doi: 10.16766/j.cnki.issn.1674-4152.002896

滨州医学院附属医院脊柱外科，山东滨州 256603

基金项目:

山东省医药卫生科技发展计划项目 2017WS752

山东省中医药科技发展计划项目 2019-0498

详细信息

通讯作者:
胡鹏，E-mail: qyhupeng@163.com

中图分类号: R681.53R616.5
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出版历程
- 收稿日期: 2022-05-17
- 网络出版日期: 2023-04-19

Short-term clinical effect analysis of unilateral biportal endoscopic surgery for of single responsible segment lumbar spinal stenosis

Department of Spine Surgery, Affiliated Hospital of Binzhou Medical University, Binzhou, Shandong 256603, China

摘要

摘要: 目的探讨单侧双通道内镜(unilateral biportal endoscopic，UBE)下椎管减压治疗单节段腰椎管狭窄症(lumbar spinal stenosis，LSS)的短期临床疗效。方法回顾性分析滨州医学院附属医院2020年6月—2021年3月脊柱外科119例LSS患者的临床资料，男性57例，女性62例，年龄为(58.3±10.0)岁，病程为(19.6±9.2)个月，责任节段L_3/4 9例，L_4/5 85例，L₅/S₁ 25例。所有患者均通过UBE技术单侧入路部分椎板切除实现单侧或双侧受压神经的充分减压。比较术前、术后3个月、12个月患者腰腿痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)；比较术前、术后1个月硬膜囊面积；评价术后12个月的临床疗效(改良MacNab标准)，并记录手术时间、术中出血量及并发症情况。结果手术均顺利完成，术中出血量为(15.3±10.0)mL，手术时间为(75.2±31.2)min，术后住院时间为(6.7±1.6)d，随访(14.5±1.4)个月。术后出现硬膜囊撕裂1例，硬膜外血肿2例。术后1个月硬膜囊面积较术前改善明显[(129.6±13.8)mm² vs. (52.6±11.5)mm²，P＜0.05]。术后3个月、12个月VAS评分及ODI指数均较术前明显改善(均P＜0.05)。临床疗效：优84例，良26例，可6例，差3例，优良率为92.4%(110/119)。结论 UBE治疗单责任节段LSS疗效确切，创伤小、操作方便、术后恢复快。
- 腰椎管狭窄症 /
- 单侧双通道内镜 /
- 微创腰椎减压 /
- 单侧椎板入路双侧椎管减压
Abstract: Objective To investigate the short-term clinical effect of spinal canal decompression under Unilateral Biportal Endoscopy (UBE) in the treatment of single-segment lumbar spinal stenosis (LSS). Methods The clinical data of 119 patients with LSS in spine surgery from June 2020 to March 2021 in the Affiliated Hospital of Binzhou Medical University were analyzed retrospectively. There were 57 males and 62 females, with an average age of (58.3±10.0) years, a course of disease of (19.6±9.2) months, segmental L_3/4 9 cases, L_4/5 85 cases and L₅/S₁ 25 cases. All patients underwent partial laminectomy through unilateral approach with UBE technology to achieve full decompression of unilateral or bilateral compressed nerves. Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were compared before operation, 3 months and 1 year after operation. The area of dural sac was compared before and 1 month after operation. The clinical efficacy (modified MacNab standard) at 1 year after operation was evaluated, and the operation time, intraoperative blood loss and complications were recorded. Results All operations were successfully completed. The intraoperative blood loss was (15.3±10.0) mL, the operation time was (75.2±31.2) min, the postoperative hospital stay was (6.7±1.6) days, and the follow-up time was (14.5±1.4) months. There were 1 case of dural sac tear and 2 cases of epidural hematoma after operation. The dural sac area was significantly improved [(129.6±13.8) mm² vs. (52.6±11.5) mm², P < 0.05] one month after operation. The VAS score and ODI were significantly improved at 3 months and 12 months after operation (all P < 0.05). The clinical efficacy was excellent in 84 cases, good in 26 cases, fair in 6 cases, and poor in 3 cases. The excellent and good rate was 92.4% (110/119). Conclusion The UBE has definite curative effect, less trauma, convenient operation and rapid postoperative recovery in the treatment of single responsible segmental LSS.
- Lumbar spinal stenosis /
- Unilateral biportal endoscopic /
- Minimally invasive lumbar decompression /
- Unilateral laminotomy for bilateral decompression

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图 1 典型病例影像资料

注：患者男性，65岁，左下肢放射性疼痛麻木3个月，术前影像学诊断为腰椎间盘突出并腰椎管狭窄，A、B、C分别为术前腰椎MR矢状位、横轴位及CT轴位，证实腰椎管狭窄；D为术中定位责任椎间隙；I为建立观察通道及工作通道(红色箭头)；J为减压后硬膜囊恢复正常搏动，外膜血管充盈，硬膜囊(蓝色箭头)、神经根(红色箭头)恢复正常的形态和路径。E、F、G、H分别为术后CT及MR：腰椎管狭窄减压充分，关节突关节骨质保留充分。

Figure 1. Imaging data of typical cases

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表 1 不同时间点LSS患者VAS评分及ODI指数比较(x±s)

Table 1. Comparison of VAS score and ODI index of LSS patients at different time points(x±s)

时间	VAS(分)	ODI(%)
术前	7.5±1.2	72.1±6.9
术后3个月	2.1±1.0^a	36.1±8.1^a
术后12个月	1.2±0.8^ab	17.2±2.9^ab
F值	771.767	1 603.564
P值	＜0.001	＜0.001
注：与术前比较，^aP＜0.001；与术后3个月比较，^bP＜0.001。

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