经椎间孔镜与单侧双通道镜治疗老年腰椎椎管狭窄症  

Percutaneous transforaminal endoscopy versus unilateral biportal endoscopy for lumbar spinal stenosis in elderly

作　　者：孟凡志[1] 代相鹏 于医波[1] 贾庆运 王传鑫 匡立华 MENG Fan-zhi;DAI Xiang-peng;YU Yi-bo;JIA Qing-yun;WANG Chuan-xin;KUANG Li-hua(Linyi Municipal Hospital of Traditional Chinese Medicine,Linyi 276000,China;People's Hospital of Linyi City,Linyi 276000,China)

机构地区：[1]临沂市中医医院,山东临沂276000 [2]临沂市人民医院,山东临沂276000

出　　处：《中国矫形外科杂志》2024年第6期493-499,共7页Orthopedic Journal of China

基　　金：山东省自然科学基金青年项目(编号:ZR2021QH230);山东省自然科学基金联合基金项目(编号:ZR2022LZY002);山东省中医药科技项目(编号:M-2022097)。

摘　　要：[目的]比较经椎间孔内镜(percutaneous transforaminal endoscopy,PTE)与单侧双通道内镜(unilateral biportal endoscopy,UBE)治疗老年退行性腰椎椎管狭窄症(degenerative lumbar spinal stenosis,DLSS)的临床疗效。[方法]回顾性分析2020年1月—2022年6月接受手术治疗的单节段DLSS 72例患者的临床资料。依据医患沟通结果,37例采用PTE术,35例采用UBE术。比较两组围手术期、随访和影像资料。[结果]PTE组手术时间[(63.2±11.0)min vs(81.2±10.3)min,P<0.001]、切口总长度[(1.0±0.2)cm vs(2.5±0.3)cm,P<0.001]、术中失血量[(39.2±10.9)ml vs(89.5±11.3)ml,P<0.001]、下地行走时间[(1.4±0.5)d vs(2.2±0.4)d,P<0.001]、住院时间[(9.2±1.4)d vs(11.2±2.1)d,P<0.001]及完全负重活动时间[(62.2±9.5)d vs(71.1±10.2)d,P<0.001]均显著优于UBE组。随时间推移,两组腰痛VAS、腿痛VAS和ODI评分均显著降低(P<0.05)。术后1 d时PTE组的腰痛VAS评分[(3.7±1.0)vs(4.3±1.1),P=0.018]、腿痛VAS[(2.9±0.5)vs(3.2±0.4),P=0.007]、ODI评分[(26.6±7.7)vs(30.3±5.4),P=0.022]均显著优于UBE组。影像方面,术后两组椎管面积较术前均显著增加(P<0.05),但随时间推移两组椎管面积均再次减少(P<0.05)。末次随访时PTE组椎管面积显著小于UBE组[(126.3±25.4)cm2vs(163.7±28.6)cm2,P<0.001]。相应时间点两组椎间隙高度和腰椎前凸角的差异均无统计意义(P>0.05)。[结论]PTE和UBE两种手术方式治疗DLSS均能取得良好临床疗效,相比UBE,PTE手术创伤小、恢复快,术后早期腰痛、腿痛轻,但UBE减压范围更大。[Objective]To compare the clinical outcomes of percutaneous transforaminal endoscopy(PTE)versus unilateral biportal en⁃doscopy(UBE)for degenerative lumbar spinal stenosis(DLSS)in the elderly.[Methods]A retrospective research was done on 72 patients who received surgical decompression for single-segment DLSS from January 2020 to June 2022.Based on surgeon-patient discussion pre⁃operatively,37 patients underwent PTE,while other 35 patients received UBE.The perioperative,follow-up and imaging data of the two groups were compared.[Results]The PTE group proved significantly superior to the UBE group in terms of operating time[(63.2±11.0)min vs(81.2±10.3)min,P<0.001],total length of incision[(1.0±0.2)cm vs(2.5±0.3)cm,P<0.001],intraoperative blood loss[(39.2±10.9)ml vs(89.5±11.3)ml,P<0.001],postoperative walk time[(1.4±0.5)days vs(2.2±0.4)days,P<0.001],hospitalization time[(9.2±1.4)days vs(11.2±2.1)days,P<0.001],and time to recover full weight-bearing activity[(62.2±9.5)days vs(71.1±10.2)days,P<0.001].The VASs for lower back pain and leg pain,as well as ODI scores were significantly decreased in both groups over time(P<0.05).The PTE group was signifi⁃cantly better than the UBE group a day postoperatively regarding to VAS score for back pain[(3.7±1.0)vs(4.3±1.1),P=0.018],VAS for leg pain[(2.9±0.5)vs(3.2±0.4),P=0.007],and ODI score[(26.6±7.7)vs(30.3±5.4),P=0.022],despite of that the differences in abovesaid scores between the two groups became not statistically significant since then(P>0.05).With respect of imaging,the canal area in both groups increased significantly postoperatively compared with those preoperatively(P<0.05),but which in both groups decreased again over time after surgery(P<0.05).At the last follow-up,PTE group was significantly inferior to the UBE group in canal aera[(126.3±25.4)cm^(2) vs(163.7±28.6)cm2,P<0.001].There were no statistically significant differences in intervertebral space height and lumbar lordosis between the two groups at any time points accordingly(P>0.05).[Co

关 键 词：老年腰椎椎管狭窄症 经椎间孔内镜技术 单侧双通道内镜 减压术 

分 类 号：R687[医药卫生—骨科学]