单侧双通道与单通道内镜下单侧椎板切开双侧减压治疗腰椎管狭窄症  

Unilateral laminotomy for bilateral decompression under unilateral biportal endoscopy and uniportal endoscopy to treat lumbar spinal stenosis

作　　者：胡宇童 徐浩严 杨东方 付豪 滕红林[4] 许卫兵 Hu Yutong;Xu Haoyan;Yang Dongfang;Fu Hao;Teng Honglin;Xu Weibing(Graduate School of Dalian Medical University,Dalian 116044,China;Department of Spine Surgery,Dalian Municipal Central Hospital,Dalian 116033,China;Department of Orthopaedics,Dandong People's Hospital,Dandong 118002,China;Department of Spine Surgery,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325015,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 [3]丹东市人民医院骨科,丹东118002 [4]温州医科大学附属第一医院脊柱外科,温州325015

出　　处：《中华骨科杂志》2023年第2期89-96,共8页Chinese Journal of Orthopaedics

摘　　要：目的比较单侧双通道内镜(unilateral biportal endoscopy,UBE)与单通道内镜(uniportal endoscopy,UE)下单侧椎板切开双侧减压(unilateral laminotomy for bilateral decompression,ULBD)治疗腰椎管狭窄症的临床疗效。方法回顾性分析大连医科大学附属大连市中心医院及温州医科大学附属第一医院2020年1月至2021年6月通过UBE或UE进行ULBD治疗的82例腰椎管狭窄症的患者资料,男36例、女46例;年龄(63.3±7.5)岁(范围47~81岁)。UBE组42例,男20例、女22例,年龄(63.2±7.6)岁(范围47~81岁);UE组40例,男16例、女24例,年龄(63.5±7.5)岁(范围48~80岁)。比较两组手术时间、住院天数和手术并发症发生率,术前、术后第1天、7天、1个月和6个月的腰腿痛视觉模拟评分(visual analogue scale,VAS)以及术前、术后1个月和6个月的Oswestry功能障碍指数(Oswestry disability index,ODI)。计算手术前后的硬膜囊面积、入路侧关节突关节切除角度、盘黄间隙减压率和骨性侧隐窝减压率。结果所有患者均顺利完成手术。UBE组手术时间为(63.1±7.0)min、住院时间(3.9±0.9)d;UE组分别为(61.2±6.2)min、(3.7±0.9)d,差异均无统计学意义(t=1.31,P=0.195;t=1.24,P=0.217)。UBE组的腰腿VAS由术前(7.19±0.97)分降至术后第1天(3.43±0.63)分、第7天(1.71±0.60)分、1个月(1.33±0.48)分和6个月(1.36±0.48)分(F=352.29,P<0.001);UE组的腰腿痛VAS评分由术前(6.85±0.89)分降至术后第1天(2.45±0.75)分、第7天(1.75±0.59)分、1个月(1.33±0.47)分和6个月(1.28±0.45)分(F=291.44,P<0.001)。术后第1天UBE组的腰腿痛VAS高于UE组(t=6.41,P<0.001),术后第7天两组差异无统计学意义(t=-0.27,P=0.786)。UBE组的ODI由术前66.62%±4.98%降至术后1个月21.81%±2.61%和6个月11.62%±2.31%(F=1991.35,P<0.001);UE组由术前64.35%±5.16%,降至术后1个月22.85%±3.26%和6个月11.15%±2.86%(F=1931.18,P<0.001)。术后UBE组的硬膜囊面积为(135.1±10.0)mm^(2)大于UE组的(120.9±10.4)mm^(2)(t=6.30,P<0.001)。术Objective To compare the clinical efficacy of unilateral biportal endoscopy(UBE)and uniportal endoscopy(UE)for unilateral laminotomy for bilateral decompression(ULBD)in the treatment of lumbar spinal stenosis.Methods Data of 82 patients with lumbar spinal stenosis treated by ULBD under UBE or UE from January 2020 to June 2021 in Dalian Central Hospital affiliated to Dalian Medical University and the First Hospital affiliated to Wenzhou Medical University were retrospectively analyzed,including 36 males and 46 females,aged 63.3±7.5 years(range,47-81 years).According to the surgical procedure,they were divided into UBE group(42 cases),including 20 males and 22 females;aged 63.2±7.6 years(range,47-81 years)and UE group(40 cases),including 16 males and 24 females;aged 63.5±7.5 years(range,48-80 years).Operation time,hospital stay and surgical complications were compared between the two groups.Visual analogue scale(VAS)of low back and leg pain before surgery,1 day,7 d,1 month and 6 months after surgery,and Oswestry disability index(ODI)before surgery,1 month and 6 months after surgery were compared.Dural sac area before and after surgery,resection angle of ipsilateral facet joint,decompression rate of disc space and bone lateral recess were calculated.Results All patients were operated successfully.In the UBE group,the operation time was 63.1±7.0 min,and the hospital stay was 3.9±0.9 d.The UE group was 61.2±6.2 min and 3.7±0.9 d,respectively(t=1.31,P=0.195;t=1.24,P=0.217).The VAS of back and legs pain in UBE group decreased from 7.19±0.97 before operation to 3.43±0.63 points at postoperative 1 day,1.71±0.60 at postoperative 7 d,1.33±0.48 at postoperative 1 month and 1.36±0.48 points at postoperative 6 months(F=352.29,P<0.001).The VAS score of the UE group decreased from 6.85±0.89 points before operation to 2.45±0.75 points at postoperative 1 day,1.75±0.59 points at postoperative 7 d,1.33±0.47 points at postoperative 1 month and 1.28±0.45 points at postoperative 6 months(F=291.44,P<0.001).The VAS of lo

关 键 词：脊柱 腰椎管狭窄 减压 椎板切除术 

分 类 号：R687.3[医药卫生—骨科学]