单侧双通道脊柱内镜在退变性腰椎疾病治疗中的再手术原因分析  

Analysis of reoperation causes in unilateral biportal endoscopy for treating lumbar degenerative diseases

作　　者：刘雨泉 李光鹏 李想 祝斌 左维阳 谭海宁 刘宁 费琦[1] 孙海波 范天奇 杨雍[1] 于凌佳 Liu Yuquan;Li Guangpeng;Li Xiang;Zhu Bin;Zuo Weiyang;Tan Haining;Liu Ning;Fei Qi;Sun Haibo;Fan Tianqi;Yang Yong;Yu Lingjia(Department of Orthopedics,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院骨科,北京100050

出　　处：《国际外科学杂志》2025年第2期108-113,I0005,共7页International Journal of Surgery

基　　金：首都医科大学附属北京友谊医院科研启动基金(yyqdktgl2021-4);北京市自然科学基金海淀项目(L202031)。

摘　　要：目的分析单侧双通道脊柱内镜(UBE)手术开展早期的再手术率和再手术原因。方法回顾性分析2021年10月—2023年6月首都医科大学附属北京友谊医院收治的由单一术者完成的180例UBE手术患者的临床资料,收集其中接受二次手术患者的临床和影像学资料,分析其再手术的原因,并对二次手术的临床疗效进行随访。计量资料以均数±标准差(x±s)表示,治疗前后比较采用t检验。结果共纳入UBE手术患者180例,其中6例患者接受再次手术治疗,再手术率为3.33%。其中3例出现在前90例手术中,另3例出现在后90例手术中。再手术原因包括:术后同节段腰椎间盘突出复发2例;椎管减压不充分2例;单纯椎管减压术后出现椎间盘脱出1例;术后即刻出现肛周麻木1例。再次手术距初次手术时间0~187 d,平均63.3 d。再次手术后平均随访时间为18.3个月,末次随访时患者的疼痛视觉模拟评分(VAS)及Oswestry功能障碍指数(ODI)评分均较术前有明显改善[腰痛VAS评分:术前(5.2±1.7)分,末次随访(1.2±0.8)分,P<0.001;腿痛VAS评分:术前(7.2±1.5)分,末次随访(1.2±1.2)分,P<0.001;ODI评分:术前(67.3±5.7)分,末次随访(20.2±8.2)分,P<0.001],术后改良MacNab评分均较为满意(优4例,66.7%;良2例,33.3%)。除1例患者开放翻修手术术中出现硬膜损伤外,无神经损伤等严重并发症。结论UBE手术开展早期,术后腰椎间盘突出复发以及减压不充分是再手术的主要原因,且常发生在初次手术后3个月内。UBE的二次手术并未显著增加神经损伤的风险。应加强术后早期随访,针对有症状的患者,二次手术充分减压可获得满意的治疗效果。Objective To analyze the reoperation rate and causes during the early adoption phase of unilateral biportal endoscopy(UBE).Methods The clinical data of 180 patients who underwent UBE performed by a single surgeon at Beijing Friendship Hospital,Capital Medical University from October 2021 to June 2023 were retrospectively analyzed.Clinical and imaging data of patients who underwent reoperation were collected to analyze the causes of reoperation,and the clinical efficacy of the reoperations was also followed up.Measurement data were expressed as mean±standard deviation(x±s),and t-test was used before and after treatment.Results A total of 180 patients who underwent UBE were included in this study,of which 6 patients underwent reoperation,and the reoperation rate was 3.33%.Among them,3 cases occurred in the first 90 surgeries and the other 3 occurred in the subsequent 90 surgeries.The causes of reoperation were as follows:recurrent lumbar disc herniation at the same segment postoperatively in 2 cases,insufficient decompression in 2 cases,disc herniation following isolated decompression in 1 case,and immediate postoperative perianal numbness in 1 case.The time between the initial surgery and reoperation ranged from 0 to 187 days,with an average of 63.3 days.The average follow-up time after reoperation was 18.3 months.The visual analogue scale(VAS)and Oswestry disability index(ODI)scores of the patients at the last follow-up were significantly improved compared with those before operation(VAS score of low back pain:5.2±1.7 before operation,1.2±0.8 at the last follow-up,P<0.001;VAS score of leg pain:7.2±1.5 before operation,1.2±1.2 at the last follow-up,P<0.001;ODI score:67.3±5.7 before operation,20.2±8.2 at the last follow-up,P<0.001).The postoperative modified MacNab scores were generally satisfactory(4 cases were rated as excellent,accounting for 66.7%;2 cases were rated as good,accounting for 33.3%).Except for one patient who experienced dural injury during open revision surgery,there were no serious compli

关 键 词：单侧双通道脊柱内镜 腰椎退变性疾病 再手术 减压 椎间盘退变 

分 类 号：R68[医药卫生—骨科学]