单边双通道内镜下单侧入路双侧减压治疗退变性腰椎管狭窄症的早期疗效观察  

Observation on the early outcomes of unilateral laminotomy with bilateral decompression in lumbar spinal stenosis under unilateral biportal endoscopy

作　　者：吴天亮 夏太宝 严政 薛双桃 桂召柳 赵广超 WU Tianliang;XIA Taibao;YAN Zheng;XUE Shuangtao;GUI Zhaoliu;ZHAO Guangchao(Department of Spinal Surgery,The Second People′s Hospital of Wuhu(Wuhu hospital,East China Normal University),Wuhu 241000,China)

机构地区：[1]华东师范大学附属芜湖医院芜湖市第二人民医院脊柱外科,安徽芜湖241000

出　　处：《皖南医学院学报》2023年第6期536-539,共4页Journal of Wannan Medical College

基　　金：芜湖市科技计划项目(2021yf65)。

摘　　要：目的:探讨单边双通道内镜(UBE)技术运用单侧入路双侧减压(ULBD)方式治疗退变性腰椎管狭窄症(DLCS)的临床疗效。方法:纳入2020年6月~2022年1月芜湖市第二人民医院脊柱外科收治的35例DLCS患者,其中男21例,女14例,平均年龄(70.2±10.8)岁,单节段减压25例,双节段减压10例,共45节段减压,病椎节段:L 3~45例次,L 4~525例次,L 5~S 115例次;均采用UBE辅助下ULBD方式减压治疗,记录手术过程中相关观察指标以及并发症发生情况,比较术前、术后3 d以及末次随访的Oswestry功能障碍指数(ODI)和腰、腿疼痛视觉模拟量表(VAS)评分,术后1年手术满意度评估采用改良Macnab评分评估。结果:所有患者均完成手术,手术时间(94.6±21.2)min,住院时间(5.5±1.2)d;平均随访(18.6±3.5)月;术中发生1例硬膜囊撕裂,术后1例下肢肌力稍下降、3例腰骶部疼痛放射至下肢;与术前比较,术后3 d和末次随访的ODI指数及腰、腿疼痛VAS评分均下降(P<0.05);手术优良率为91.43%。结论:UBE技术下ULBD手术方式治疗DLCS创伤小,恢复更快,手术安全性更高,术中减压效果更确切,是治疗双侧症状DLCS的有效微创术式。Objective:To observe the clinical efficacy of unilateral laminotomy with bilateral decompression(ULBD)in the treatment of degenerative lumbar canal stenosis(DLCS)under unilateral biportal endoscopy(UBE).Methods:Thirty-five patients with DLCS treated in our hospital were included from June 2020 to January 2022.Of the 35 patients,21 were males,and 14 females.The average ages were(70.2±10.8)years.Twenty-five cases received unilateral segmental decompression,and another 10 underwent bilateral segmental decompression(decompression was done in a total of 45 segments).The diseased segment included 5 cases at L 3-4,25 cases at L 4-5,and 15 cases at L 5-S 1.All patients underwent ULBD under UBE.The related intraoperative indicators as well as complications were recorded,and comparison was made regarding the Oswestry disability index(ODI)and VAS scores for waist and leg pain before operation,3 days after operation,and at final follow-up after surgery.Modified Macnab criteria were used to evaluate satisfaction with the surgery by the 12 th month after operation.Results:The surgery was successfully completed in all patients.The operative time,days of hospital stay and average days of follow-up were(94.6±21.2)min,(5.5±1.2)d,and(18.6±3.5)months,respectively.Intraoperative tear of dural sac occurred in 1 case.One patient was complicated with muscle strength decrease after operation,and another 3 with residual lumbosacral pain.ODI index and VAS scores for waist and leg were significantly decreased at 3 days after surgery and final follow-up after surgery compared to the indicators observed before operation(P<0.05).The excellent and good rates were 91.43%for the operation.Conclusion:BLBD under UBE possesses less trauma,fast recovery and higher safety in the treatment of DLCS.In addition,the decompression is effective by this minimally invasive surgery.

关 键 词：单边双通道内镜 单侧入路双侧减压 腰椎管狭窄症 

分 类 号：R687.3[医药卫生—骨科学]