单侧双通道内镜技术与显微内窥镜技术治疗单节段腰椎管狭窄症的疗效比较  

Comparison of unilateral biportal endoscopy and microendoscopy for single-level lumbar spinal stenosis

作　　者：胡辉林 刘雄文 谭斌 刘少野 莫宗平 HU Hui-lin;LIU Xiong-wen;TAN Bin;LIU Shao-ye;MO Zong-ping(Department of Orthopedics,the Guangxi Zhuang Autonomous Region Brain Hospital,Liuzhou 545005,Guangxi,China)

机构地区：[1]广西壮族自治区脑科医院骨科,广西柳州545005

出　　处：《广东医学》2024年第8期988-992,共5页Guangdong Medical Journal

基　　金：广西壮族自治区卫生和计划生育委员会自筹经费科研课题(Z20170199)。

摘　　要：目的比较单侧双通道内镜(UBE)技术与显微内窥镜(MED)技术行椎板开窗减压术治疗单节段腰椎管狭窄症的疗效。方法对比分析行手术治疗的86例单节段腰椎管狭窄症患者,其中UBE组45例,MED组41例。记录手术时间、术后卧床时间,观察术前、术后第3天、术后1周、末次随访时疼痛视觉模拟评分(VAS),观察术前、末次随访时的Oswestry功能障碍指数(ODI),末次随访时采用改良Macnab标准评估手术效果。结果86例患者均顺利完成手术,并获得12~33个月的随访,UBE组较MED组手术时间长(P<0.05)、术后卧床时间短(P<0.05),两组术后VAS评分和0ODI均较术前改善(P<0.05),不同时间点两组间VAS评分和ODI的改善值差异均无统计学意义(P>0.05)。按改良Macnab标准UBE组手术优良率为91.11%,MED组为90.24%,差异无统计学意义(P>0.05)。UBE组术中硬脊膜损伤1例,术后神经根牵拉致麻木乏力1例,经对症处理后恢复;MED组术中未出现硬脊膜损伤,术后神经根牵拉致麻木乏力2例,经对症处理后恢复。结论UBE技术与MED技术治疗单节段腰椎管狭窄症临床疗效相似,UBE技术较MED技术手术时间长、术后卧床时间短。Objective To compare the efficacy of unilateral biportal endoscopy(UBE)and microendoscopy(MED)in performing laminotomy for decompression in single-level lumbar spinal stenosis.Methods A comparative analysis was conducted on 86 patients with single-level lumbar spinal stenosis who underwent surgery,with 45 cases in the UBE group and 41 cases in the MED group.Surgical time and postoperative bed rest duration were recorded.Pain visual analog scale(VAS)scores were assessed preoperatively,on the third day postoperatively,one week postoperatively,and at the final follow-up.The Oswestry Disability Index(ODI)was evaluated preoperatively and at the final follow-up.Surgical outcomes were assessed using the modified Macnab criteria at the final follow-up.Results All 86 patients successfully underwent surgery and were followed up for 12 to 33 months.The UBE group had a longer surgical time(P<0.05)and shorter postoperative bed rest duration(P<0.05)compared to the MED group.Both groups showed significant improvement in postoperative VAS scores and ODI compared to preoperative values(P<0.05),with no significant differences between the two groups at different time points(P>0.05).According to the modified Macnab criteria,the excellent and good rate was 91.11%in the UBE group and 90.24%in the MED group,with no statistically significant difference(P>0.05).In the UBE group,there was one case of intraoperative dural tear and one case of postoperative nerve root traction-induced numbness and weakness,both of which resolved with symptomatic treatment.In the MED group,there were no intraoperative dural tears,but two cases of postoperative nerve root traction-induced numbness and weakness,both of which resolved with symptomatic treatment.Conclusion UBE and MED techniques have similar clinical efficacy in treating single-level lumbar spinal stenosis.UBE is associated with longer surgical time but shorter postoperative bed rest duration compared to MED.

关 键 词：腰椎 椎管狭窄 椎管减压术 内窥镜 微创手术 

分 类 号：R683[医药卫生—骨科学] R687.3[医药卫生—外科学]