单侧双通道内镜治疗多节段退变性腰椎疾病  

Unilateral biportal endoscopy for the treatment of multilevel degenerative lumbar disease

作　　者：李冬月[1] 苏庆军[1] 张希诺[1] 陶鲁铭 海涌[1] LI Dong-yue;SU Qing-jun;ZHANG Xi-nuo;TAO Lu-ming;HAI Yong(Department of Orthopaedics,Beijing Chaoyang Hospital,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：《中国矫形外科杂志》2024年第19期1807-1810,1815,共5页Orthopedic Journal of China

摘　　要：[目的]探讨单侧双通道脊柱内镜技术(unilateral biportal endoscopy,UBE)治疗多节段退变性腰椎疾病(multilevel degenerative lumbar disease,MDLD)的安全性和临床疗效。[方法]回顾性分析2020年7月—2022年6月本科收治的29例MDLD患者的临床资料,均采用UBE技术治疗。评价临床及影像结果。[结果]29例患者均顺利完成手术,手术时间平均(178.6±26.5)min,术中透视次数平均(10.9±2.9)次。并发症方面,硬膜囊撕裂2例,短暂性下肢麻木2例,硬膜外血肿1例,均未引起严重不良后果。随访时间平均(19.3±6.3)个月,随术前、术后7 d、术后3个月至术后12个月的时间推移,VAS评分[(6.6±1.5),(3.2±0.5),(2.1±0.6),(1.7±0.5),P<0.001]、ODI评分[(58.6±11.2),(33.5±4.6),(22.8±3.8),(17.5±2.2),P<0.001]、JOA评分[(15.6±2.4),(19.6±2.0),(21.2±2.2),(24.7±2.5),P<0.001]均显著改善。术后12个月,按改良Mac Nab疗效评定标准,优良率86.2%。影像方面,与术前相比,术后12个月椎管面积显著增加[(58.3±9.6) mm^(2),(118.4±14.2) mm^(2),P<0.001]。术后各节段关节突关节面积保留率均超过60%。[结论]UBE技术治疗MDLD的临床效果满意,保留更多小关节突,有利于维持腰椎的稳定性,是一种安全有效的术式。[Objective]To explore the safety and clinical efficacy of unilateral biportal endoscopy(UBE)in the treatment of multileveldegenerative lumbar disease(MDLD).[Methods]Twenty nine patients who received surgical decompression with UBE for MDLD from July2020 to June 2022 were retrospectively analyzed.The clinical and imaging data were evaluated.[Results]All the 29 patients successfullycompleted the operation,with the average operation time of(178.6±26.5)min,the average intraoperative fluoroscopy times of(10.9±2.9).Interm of complication,dural tear happened in 2 cases,transient lower limb numbness in 2 cases,and epidural hematoma in 1 case,which notled serious consequence in anyone of them.The follow-up period lasted for(19.3±6.3)months in average.As time went from the point beforesurgery,to 7 days,3 months and 12 months postoperatively,the VAS score for pain[(6.6±1.5),(3.2±0.5),(2.1±0.6),(1.7±0.5),P<0.001],ODIscore[(58.6±11.2),(33.5±4.6),(22.8±3.8),(17.5±2.2),P<0.001],JOA score[(15.6±2.4),(19.6±2.0),(21.2±2.2),(24.7±2.5),P<0.001]signifi-cantly improved.At 12 months after operation,the excellent and good rate was of 86.2%,according to the modified MacNab criteria.In termsof imaging,there was a significant increase in spinal canal area at 12 months after surgery compared with that preoperatively[(58.3±9.6)mm^(2),(118.4±14.2)mm^(2),P<0.001].The retention rate of facet joints was more than 60%in all levels.[Conclusion]The UBE used in thetreatment of MDLD does achieve satisfactory clinical outcomes,with a benefit to maintain the stability of lumbar spine by preserving morefacet joints,is a safe and effective operation.

关 键 词：单侧双通道内镜技术 多节段退变性腰椎疾病 临床疗效 

分 类 号：R681.57[医药卫生—骨科学]