单侧双通道内镜下椎板开窗减压术在腰椎管狭窄症中的应用  

Clinical effects of unilateral biportal endoscopy fenestration discectomy for lumbar spinal stenosis

作　　者：何方生[1] 韩鹏远[1] 王晓楠[1] 张伟亚[1] 周丽娜 吴兵[1] He Fangsheng;Han Pengyuan;Wang Xiaonan;Zhang Weiya;Zhou Lina;Wu Bing(Department of Spinal Surgery,Shihezi People's Hospital,Shihezi Xinjiang,832000,China)

机构地区：[1]石河子市人民医院脊柱外科,新疆石河子832000

出　　处：《生物骨科材料与临床研究》2023年第2期33-37,共5页Orthopaedic Biomechanics Materials and Clinical Study

基　　金：石河子市重点领域科技攻关项目(2022NY05)。

摘　　要：目的 探讨单侧双通道内镜下椎板开窗减压术在腰椎管狭窄症中的应用。方法 回顾性分析2019年11月至2021年11月石河子市人民医院收治的39例保守治疗无效单侧下肢症状的腰椎管狭窄症患者的资料。其中,男19例,女20例;年龄55~80岁,平均60.5岁;病程4~25周,平均12.5周。病变节段L3-45例,L4-530例,L5-S14例。记录手术时间、术中出血量、手术切口长度及并发症发生情况。采用疼痛视觉模拟评分法(VAS)和改良的Oswestry功能障碍指数(ODI)比较术前、术后1 d及术后1个月、3个月、1年和末次随访的结果评估手术疗效。末次随访时按MacNab标准评估治疗有效率。结果 所有患者均顺利完成手术,并均获得随访,随访时间为12~23个月,平均(16.2±3.2)个月。患者的手术时间为(61.55±5.36) min、术中出血量为(50.20±7.53) mL、手术切口长度为(14.26±2.66) cm。术后各时间点腰腿疼痛VAS评分及ODI较术前均明显下降,差异有统计学意义(P<0.05);术后各时间点间比较,差异无统计学意义(P>0.05)。术后有1例出现下肢麻木,感觉过敏;有2例患者硬膜囊撕裂;无感染发生。结论 在腰椎管狭窄症中应用UBE行镜下椎板开窗减压术是安全、有效的,为腰椎管狭窄症的微创治疗提供了选择。Objective To investigate the application of unilateral biportal endoscopy fenestration discectomy for lumbar spinal stenosis.Methods Retrospective analysis:From November 2019 to November 2021,39 patients(19 males and 20 females)with lumbar spinal stenosis with unilateral lower limb symptoms who failed to respond to conservative treatment were included in this study.The average age was 60.5 years old(55-80 years old).The duration of the disease was 4-25 weeks,with an average of 12.5 weeks.There were 39 cases,including 5 cases in lesion segment L3-4,30 cases in L4-5 and 4 cases in L5-S1 in this study.The operation time,intraoperative blood loss,incision length and complications were recorded.Visual analogue scale(VAS)and modified Oswestry disability index(ODI)were used to compare the results of preoperative,postoperative 1 day,1,3 months,1 year and the last follow-up to evaluate the surgical efficacy.At the last follow-up,the treatment efficacy was evaluated according to the MacNab standard.Results All patients successfully completed the operation and were followed up.The follow-up period was 12-23 months,the average follow-up time was(16.2±3.2)months.The operation time was(61.55±5.36)min,the intraoperative blood loss was(50.20±7.53)mL,and the length of the surgical incision was(14.26±2.66)cm.The VAS score and ODI of low back and leg pain at each time point after surgery were significantly lower than those before surgery,with a statistically significant difference(P<0.05).There was no statistically significant difference between the time points after surgery(P>0.05).There was 1 case of lower limb numbness and hypersensitivity after operation,2 patients with dural tear,and no infection occurred.Conclusion UBE is safe and effective in the treatment of lumbar spinal stenosis.It is an option for minimally invasive treatment of lumbar spinal stenosis.

关 键 词：双通道内镜 椎板开窗术 腰椎管狭窄 腰椎退行性疾病 

分 类 号：R681.57[医药卫生—骨科学]