单侧双通道内镜下融合术治疗单节段腰椎椎管狭窄症的短期临床疗效  

Short Term Efficacy of Unilateral Biportal Endoscope for Single Segment Lumbar Spinal Stenosis

作　　者：陈栎昀 方煌 王欢[1] CHEN Li-yun;FANG Huang;WANG Huan(Department of Orthopaedics,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院骨科,武汉430030

出　　处：《骨科》2022年第5期395-399,共5页ORTHOPAEDICS

摘　　要：目的探讨采用单侧双通道内镜(UBE)技术行内镜下腰椎管减压、椎间植骨融合,并联合经皮椎弓根螺钉内固定术治疗单节段腰椎椎管狭窄症的短期临床疗效。方法回顾性分析2020年1月1日至2021年6月1日于我院行手术治疗单节段腰椎椎管狭窄症的47例病人的临床资料,根据手术方案分组。其中运用UBE技术行内镜下腰椎管减压、椎间植骨融合,并联合经皮椎弓根螺钉内固定术的19例纳入UBE镜下融合组,男8例,女11例,年龄为(58.95±10.21)岁;行传统开放经椎间孔入路椎间融合术(TLIF)的28例纳入TLIF组,男13例,女15例,年龄为(58.04±10.83)岁。收集并比较两组病人的手术时间、术中出血量、术后住院时间、背部和下肢疼痛视觉模拟量表(VAS)评分和Oswestry功能障碍指数(ODI)。结果UBE镜下融合组的手术时间、术中出血量和术后住院时间均明显低于TLIP组,差异有统计学意义(P<0.05)。47例病人术后1周和术后6个月的背部和下肢VAS评分及ODI均较术前明显降低,差异有统计学意义(P<0.05)。UBE镜下融合组术后1周的背部VAS评分显著低于TLIF组[(1.11±0.81)分vs.(4.50±1.26)分],且其背部VAS评分改善情况显著优于TLIF组[(4.89±1.60)分vs.(2.14±1.11)分],差异有统计学意义(P<0.05)。两组手术节段融合率无明显差异。结论采用UBE技术行内镜下腰椎管减压、椎间植骨融合,并联合经皮椎弓根螺钉内固定术治疗单节段腰椎椎管狭窄症是一种可行的临床治疗手段,术后早期病人的腰痛缓解程度优于传统开放手术。Objective To discuss the short term efficacy of percutaneous pedicle screw fixation under unilateral biportal endoscope(UBE) in the treatment of single segment lumbar spinal stenosis. Methods The clinical data of 47 patients with single segment lumbar spinal stenosis who underwent surgery in our hospital from January 2020 to June 2021 were retrospectively analyzed. They were divided into UBE group and TLIF group according to the surgical procedures. There were 19 cases in UBE group, 8 males and 11 females, with an age of(58.95±10.21) years, and 28 cases in TLIF group, 13 males and 15 females, with an age of(58.04±10.83)years. The operation time, intraoperative bleeding, postoperative hospital stay, Visual Analogue Scale(VAS)score of back and lower limb pain and Oswestry dysfunction index(ODI) were collected and compared between the two groups. Results The operation time, intraoperative bleeding and postoperative hospital stay in the UBE group were significantly lower than those in the TLIF group, and the difference was statistically significant(P<0.05). VAS scores and ODI of the back and lower limbs in 47 patients were significantly lower at 1st week and 6th months after operation than those before operation(P<0.05). At 1st week after operation, the back VAS score in UBE group was significantly lower than that in TLIF group(1.11 ± 0.81 vs. 4.50 ± 1.26), and the improvement of back VAS score in UBE group was significantly better than that in TLIF group(4.89±1.60 vs.2.14±1.11)(P<0.05). There was no significant difference between the two groups in the fusion rate of surgical segments. Conclusion UBE percutaneous pedicle screw internal fixation is a feasible clinical treatment for single segment lumbar spinal stenosis, and the relief of low back pain of patients in the early postoperative period is better than that of traditional open surgery.

关 键 词：腰椎 椎管狭窄 内镜手术 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]