单侧双通道脊柱内镜技术治疗退变性腰椎疾病对术后腰椎稳定性影响的临床研究  

Clinical study of lumbar stability after unilateral biportal endoscopy in the treatment of degenerative lumbar diseases

作　　者：李冬月[1] 苏庆军[1] 张希诺[1] 陶鲁铭 海涌[1] Li Dongyue;Su Qingjun;Zhang Xinuo;Tao Luming;Hai Yong(Department of Orthopaedic,Beijing Chaoyang Hospital Affiliated to Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院骨科,北京100020

出　　处：《中华外科杂志》2024年第3期187-193,共7页Chinese Journal of Surgery

摘　　要：目的探讨单侧双通道脊柱内镜技术(UBE)治疗退变性腰椎疾病的临床效果及其对术后腰椎稳定性的影响。方法本研究为回顾性病例系列研究。回顾性分析2020年7月至2022年6月首都医科大学附属北京朝阳医院骨科采用UBE治疗的109例退变性腰椎疾病患者的临床资料。男性47例,女性62例,年龄(53.3±8.2)岁(范围:21~80岁)。手术节段为单节段80例,双节段25例,三节段4例。记录患者围手术期情况及手术并发症情况;采用疼痛视觉模拟评分(VAS)、日本骨科协会(JOA)评分、Oswestry功能障碍指数(ODI)和改良MacNab标准评价临床疗效;手术前后行腰椎CT三维重建检查,观察并测量关节突关节保留情况和关节突关节切除内侧角(β角);术后12个月行过屈、过伸位腰椎X线片检查,观察腰椎稳定性。数据比较采用配对样本t检验或广义估计方程。结果109例患者均顺利完成手术,手术时间(94.5±37.1)min(范围:56~245 min),术中透视(6.8±4.0)次(范围:4~16次),住院时间(5.3±3.7)d(范围:4~14 d)。术中出现硬膜囊撕裂4例,短暂性下肢麻木4例,硬膜外血肿2例。患者术后随访(19.6±7.2)个月(范围:12~36个月)。术后3个月、12个月随访时,患者腰部VAS、腿部VAS、JOA评分和ODI均较术前明显改善(P值均<0.05)。术后12个月随访时依据改良MacNab标准,优良率为88.99%(97/109)。1例患者术后2个月因椎间盘再次突出行腰椎固定融合术治疗。影像学方面,采用UBE手术侧的关节突关节面积保留率均超过60%,β角均小于90°;术后12个月复查过屈、过伸位腰椎X线片,未见手术节段不稳定或滑脱。结论UBE治疗退变性腰椎疾病的临床效果较满意,术后患者的腰椎稳定性较好。Objectives To investigate the clinical efficacy of unilateral biportal endoscopy(UBE)in the treatment of degenerative lumbar disease(DLD)and its impact on postoperative lumbar stability.Methods This is a retrospective case series study.A total of 109 cases of DLD treated with UBE in the Department of Orthopaedic,Beijing Chaoyang Hospital Affiliated to Capital Medical University from July 2020 to June 2022 were analyzed retrospectively.There were 47 males and 62 females,aged(53.3±8.2)years(range:21 to 80 years).The surgical segments were single segment in 80 cases,two segments in 25 cases,and three segments in 4 cases.The low back pain and leg pain of visual analogue scale(VAS),Japanese Orthopaedic Association(JOA)score and Oswestry disability index(ODI)were evaluated before and after operation.The modified MacNab criteria were used for evaluation of the clinical consequences.Postoperative three-dimensional lumbar CT was performed to observe the preservation of the facet joints and the angle of the medial surface of the facetectomy(βangle).At 12 months after surgery,X ray of the flexion and extension lumbar spine were reviewed.The comparison and analysis of the data were conducted using paired sample t tests or generalized estimation equations.Results All 109 patients underwent operative procedures successfully.The operation time was(94.5±37.1)minutes(range:56 to 245 minutes),the times of X ray was 6.8±4.0(range:4 to 16 times),and the days of hospitalization was(5.3±3.7)days(range:4 to 14 days).Complications included dural tears in 4 cases,transient lower limb numbness in 4 cases,epidural hematoma in 2 case.The follow-up time was(19.6±7.2)months(range:12 to 36 months).The postoperative low back pain VAS,leg pain VAS,JOA score and ODI were significantly improved(all P<0.05).According to the modified MacNab criteria,the excellent and good rate was 88.99%(97/109)at 12 months after surgery.One case underwent revision surgery because of recurrent lumbar disc herniation.In term of radiographic evaluation,the area

关 键 词：腰椎 椎间盘疾病 单侧双通道技术 退变性腰椎疾病 脊柱内镜 临床疗效 腰椎稳定性 

分 类 号：R687.3[医药卫生—骨科学]