单侧双通道脊柱内镜治疗中央型腰椎管狭窄症的疗效评价  

Effect of unilateral biportal endoscopy for central lumbar spinal stenosis

作　　者：石立刚 匡正达 郭艾[2] 韦兴 Shi Ligang;Kuang Zhengda;Guo Ai;Wei Xing(Department of Spinal Center,Beijing Mentougou District Hospital,Beijing 102300,China;Department of Orthopedics,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Orthopedics,Aerospace Center Hospital,Beijing 100049,China)

机构地区：[1]北京市门头沟区医院脊柱中心,北京102300 [2]首都医科大学附属北京友谊医院骨科,北京100050 [3]航天中心医院骨科,北京100049

出　　处：《国际外科学杂志》2022年第11期757-761,F0003,共6页International Journal of Surgery

基　　金：国家重点研发计划资助(2019YFC0121400)。

摘　　要：目的评价单侧双通道脊柱内镜治疗中央型腰椎管狭窄症的疗效。方法采用回顾性病例对照研究的方法分析2019年11月—2021年9月北京市门头沟区医院收治的36例接受单侧双通道脊柱内镜治疗中央型腰椎管狭窄症患者的临床资料,其中男19例,女17例;L5~S111例;L4~L519例,L3~L46例;年龄(70.0±3.9)岁,年龄范围55~82岁。评估手术前后腰椎核磁横断面硬膜囊面积的改变,评估术后1、3、6、12个月的疼痛视觉模拟(VAS)评分和Oswestry功能障碍指数(ODI)较术前的改善情况,手术时间,术中出血量以及并发症的发生。正态分布的计量资料以均数±标准差(±s)表示,手术前后比较采用t检验;计数资料组间比较采用χ2检验或Fisher确切概率法。结果术后核磁显示黄韧带切除,横断面硬膜囊面积由术前的(65.5±6.7)mm^(2)增大至术后(173.5±5.5)mm^(2),差异有统计学意义(P<0.05)。36例患者术后12个月随访显示,VAS评分由术前的(8.5±0.6)分减少至(1.3±0.5)分,ODI由术前的(59.3±12.3)%减少至(13.6±1.6)%,差异均有统计学意义(P<0.05)。手术时间(52±21)min,术中出血量为(70±15)mL。36例患者均未发生与手术相关的神经损伤、脑脊液漏和感染等并发症。结论单侧双通道脊柱内镜在中央型腰椎管狭窄症治疗上症状改善明显,椎管硬膜囊面积增大,是安全、有效的治疗方法之一,能够获得良好的早期临床疗效。Objective To evaluate the efficacy of unilateral biportal endoscopy(UBE)in the treatment of central lumbar spinal stenosis.Methods The retrospective case-control study was conducted.36 patients with central lumbar spinal stenosis were treated by unilateral dual channel spinal endoscopy who underwent Beijing Mentougou District Hospital from November 2019 to September 2021 were collected.There were 19 males and 17 females,including 11 cases of L5-S1,19 cases of L4-L5 and 6 cases of L3-L4;The age was(70.0±3.9)years old,and ranged from 55 to 82 years old.The observation indicators:the changes of dural sac area in lumbar magnetic resonance cross-section before and after surgery,and the improvement of visual analogue of pain(VAS)score and Oswestry dysfunction index(ODI)before and after surgery in 1,3,6,and 12 months,as well as the occurrence of complications.Measurement data with normal distribution were represented as mean±standard deviation(±s),and comprison between groups was conducted using the t test;Comprison between groups of count data was conducted using the chi-square test or Fisher exact probability.Results Postoperative MRI showed that the area of the transverse dural sac increased from(65.5±6.7)mm^(2) before operation to(173.5±5.5)mm^(2) after operation after the removal of the ligamentum flavum(P<0.05).The follow-up of 36 patients for 12 months after operation showed that the VAS score decreased from(8.5±2.0)scores to(1.3±0.8)scores,and the ODI decreased from(59.3±12.3)%to(13.6±1.6)%(P<0.05).No complications such as nerve injury,cerebrospinal fluid leakage and infection related to operation occurred in 36 patients.Conclusions Unilateral biportal endoscopy is one of the safe and effective treatment methods in the treatment of central lumbar spinal stenosis,with obvious improvement in symptoms,and the increase in the area of the spinal dural sac.It can obtain good early clinical effects.

关 键 词：脊柱 椎管狭窄 单侧双通道脊柱内镜 中央型腰椎管狭窄症 疗效 

分 类 号：R687.3[医药卫生—骨科学]