单侧双通道内镜下减压与全椎板切除减压融合内固定治疗重度腰椎管狭窄症的对比研究  

Comparative study of decompression of unilateral biportal endoscopic compared to laminectomy with fusion and internal fixation in the treatment of severe lumbar spinal stenosis

作　　者：胡宇童 付豪 杨东方 王鑫 许卫兵 Hu Yutong;Fu Hao;Yang Dongfang;Wang Xin;Xu Weibing(Graduate School of Dalian Medical University,Dalian 116044,China;Department of Spinal Surgery,Dalian Central Hospital,Dalian Medical University,Dalian 116033,China)

机构地区：[1]大连医科大学研究生院,大连116044 [2]大连医科大学附属大连市中心医院脊柱外科,大连116033

出　　处：《中华医学杂志》2022年第41期3281-3287,共7页National Medical Journal of China

基　　金：国家重点研发计划(2019YFC0121400)。

摘　　要：目的比较单侧双通道内镜(UBE)下行单侧椎板切开双侧减压(ULBD)与后路腰椎椎体间融合术(PLIF)治疗重度腰椎管狭窄症的临床疗效。方法收集大连医科大学附属大连市中心医院2018年4月至2021年4月通过PLIF和UBE-ULBD治疗的64例重度腰椎管狭窄症患者的临床资料,根据接受手术术式的不同分为UBE组和PLIF组。UBE组30例,男12例,女18例,年龄(69.8±6.8)岁;PLIF组34例,男15例,女19例,年龄(69.3±6.3)岁。记录分析两组的手术时间、术中出血量、手术并发症、术后引流量、是否输血、术后下地时间、术后出院时间、手术成本情况。记录两组术前、术后1 d、1个月、6个月和1年的腰/腿疼痛视觉模拟评分(VAS),术前、术后1个月、6个月和1年的Oswestry功能障碍指数(ODI),术前和术后6个月MRI下硬膜囊横截面积(DSCA)及Schizas标准分级。结果UBE组手术时间为(69.2±8.0)min,低于PLIF组的(139.0±15.3)min(P<0.05);UBE组术中和术后出血量为(19.5±5.6)和(15.0±10.8)ml,低于PILF组的(212.4±34.1)和(169.6±43.8)ml(均P<0.05);UBE组术后下地时间和术后出院时间为(1.8±0.7)和(3.0±0.9)d,低于PLIF组的(4.5±1.4)和(7.1±1.7)d(均P<0.05);UBE组手术费用也低于PLIF组[人民币(1.84±0.10)万元比(3.39±0.24)万元,P<0.05],且UBE组无输血病例;UBE组2例发生硬膜囊破裂,PLIF组3例出现硬膜囊破裂、1例神经根损伤和1例感染。UBE组术后的腰疼VAS评分均较术前改善(均P<0.05),而PLIF组术后1 d腰疼VAS评分较术前无明显改善,但术后1个月、6个月及1年均较术前改善(均P<0.05);UBE组术后1 d腰疼VAS评分和术后1个月ODI优于PLIF组(均P<0.05),而两组术后1个月、6个月和1年的腰疼VAS评分和术后6个月和1年的ODI差异均无统计学意义(均P>0.05)。两组术后DSCA均较术前扩大(均P<0.05),PLIF组术后DSCA较UBE组更大(P<0.05);Schizas标准分级上,UBE组术后25例恢复至A级,5例至B级,PLIF组术后30例恢复至A级,4例恢复至B级,�Objective To compare the clinical efficacy of unilateral biportal endoscopy unilateral laminotomy for bilateral decompression(UBE-ULBD)to posterior lumbar interbody fusion(PLIF)in the treatment of severe lumbar spinal stenosis(SLSS).Methods The clinical data of 64 patients with SLSS treated with PLIF and UBE-ULBD in Dalian Central Hospital Affiliated to Dalian Medical University from April 2018 to April 2021 were collected and divided into UBE group and PLIF group according to the different surgical procedures.There were 30 cases in the UBE group,including 12 males and 18 females,aged(69.8±6.8)years.There were 34 patients in the PLIF group,including 15 males and 19 females,aged(69.3±6.3)years.The operation time,intraoperative blood loss,surgical complications,the volume of drainage,transfusion,post-operative bed rest time,postoperative hospital stay,surgical costs of both groups were recorded and analyzed.The visual analogue scales(VAS)of back/leg pain(pre-operation and 1 d,1 month,6 month,12 month post-operation)and Oswestry disability index(ODI)(pre-operation and 1 month,6 month,12 month post-operation)were used to determine the outcome.And the dural sac cross-sectional area(DSCA)and Schizas grade of both groups preoperatively and 6 month postoperatively were recorded.Results The operation time in the UBE group was(69.2±8.0)min,it was lower than that in the PLIF group(139.0±15.3)min(P<0.05).The intraoperative blood loss and drainage in the UBE group were(19.5±5.6)ml and(15.0±10.8)ml,which were both lower than those in the PILF group[(212.4±34.1)ml and(169.6±43.8)ml](both P<0.05).The postoperative bed rest time and hospital stay in the UBE group were(1.8±0.7)days and(3.0±0.9)days,which were both shorter than those in the PLIF group[(4.5±1.4)days and(7.1±1.7)days](both P<0.05).The surgical cost was also lower in the UBE group than that in the PLIF group[RMB,(18.4±1.0)thousands yuan vs(33.9±2.4)thousands yuan,P<0.05].In addition,no patient received blood transfusion in the UBE group.Dural sac tear oc

关 键 词：椎管狭窄 重度腰椎管狭窄症 单侧双通道内镜 单侧椎板切开双侧减压 后路腰椎椎体间融合术 

分 类 号：R687.3[医药卫生—骨科学]