单侧双通道内镜辅助下双侧减压治疗腰椎管狭窄症

doi:10.3969/j.issn.1006-7795.2023.04.027

摘要/Abstract

摘要： 目的探讨单侧双通道脊柱内镜（unilateral biportal endoscopy，UBE）辅助下双侧椎管减压（unilateral laminotomy for bilateral decompression，ULBD）治疗腰椎管狭窄症（lumbar spinal stenosis，LSS）的安全性和临床疗效。方法回顾性分析2020年7月至2021年12月UBE辅助下ULBD治疗的腰椎管狭窄症患者31例。L3/4节段1例，L4/5节段17例，L5/S1节段13例。术前、术后1、3、12个月随访时进行腰痛、腿痛视觉模拟量表（Visual Analogue Scale，VAS)评分和Oswestry功能障碍指数 (Oswestry Disability Index，ODI)评估，应用改良MacNab标准评价临床疗效。术后12个月复查过屈过伸位腰椎X线片。结果 31例患者均顺利完成手术，手术时间（101.52±10.57） min。术中硬脊膜撕裂1例，短暂性下肢麻木1例。平均随访（19.97±4.27）个月。腰痛VAS评分术前（4.68±1.40）分，术后1、3、12个月随访时分别降至（2.08±0.68）分、（1.77±0.48）分、（1.36±0.55）分（P<0.05）；腿痛VAS评分术前（6.01±1.37）分，术后1、3、12个月随访时分别降至（2.61±0.68）分、（2.11±0.74）分、（1.67±0.45）分（P<0.05）；ODI评分术前（57.74±10.82）分，术后1、3、12个月随访时分别降至（31.13±3.38）分、（21.84±3.33）分、（17.06±1.60）分（P<0.05）。术后12个月随访时依据改良MacNab标准，优23例，良4例，可4例，优良率87.1%。术后12个月随访复查未见手术节段失稳。结论 UBE辅助下ULBD治疗LSS的临床效果满意，可保持腰椎的稳定性，手术创伤小、术后恢复快，并且无严重的、不可逆的手术相关并发症发生。

关键词: 单侧双通道脊柱内镜, 双侧椎管减压, 腰椎管狭窄症

Abstract: Objective To investigate the surgical safety and clinical efficacy of unilateral laminotomy for bilateral decompression (ULBD) assisted by unilateral biportal endoscopy (UBE) in the treatment of lumbar spinal stenosis (LSS). Methods 31 patients with lumbar spinal stenosis treated by UBE-assisted ULBD from July 2020 to December 2021 were analyzed retrospectively. There were L3/4 in 1 case, L4/5 in 17 cases and L5/S1 in 13 cases. The Visual Analogue Scale (VAS) for low back pain and leg pain respectively, and Oswestry Disability Index (ODI) were evaluated before operation, 1 month, 3 months and 12 months after operation. The modified MacNab criteria were used for evaluation of the clinical consequences. Lumbar X-ray in the excessive flexion and extension position were reexamined at 12 months after operation. Results All 31 patients successfully completed the operation, and the time was （101.52 ± 10.57）min. Complications included dural tears in 1 case and transient numbness of lower limbs in 1 case. The average follow-up was （19.97±4.27） months. The VAS score of low back pain decreased from 4.68 ± 1.40 before operation to 2.08 ± 0.68, 1.77 ± 0.48 and 1.36 ± 0.55 at 1 month, 3 months and 12 months after operation, respectively (P <0.05); The VAS score of leg pain decreased from 6.01 ± 1.37 before operation to 2.61 ± 0.68, 2.11 ± 0.74 and 1.67 ± 0.45 at 1 month, 3 months and 12 months after operation, respectively (P<0.05). The ODI score was 57.74 ± 10.82 before operation and decreased to 31.13 ± 3.38, 21.84 ± 3.33 and 17.06 ± 1.60 at 1 month, 3 months and 12 months after operation, respectively (P<0.05). According to the modified MacNab criteria, the final clinical outcome was excellent in 23 cases, good in 4 cases, fair in 4 cases at the follow-up of 12 months, with the excellent and good rate of 87.1%. After 12 months follow-up, no instability of surgical segments was found by lumbar X-ray in the excessive flexion and extension position. Conclusions ULBD assisted by UBE in the treatment of LSS has a satisfactory clinical effect, maintains the good lumbar stability, and has the advantages of small surgical injury and fast recovery.

Key words: unilateral biportal endoscopy (UBE), unilateral laminotomy for bilateral decompression (ULBD), lumbar spinal stenosis (LSS)

中图分类号:

R687.3

陶鲁铭, 李冬月, 张希诺, 苏庆军, 海涌. 单侧双通道内镜辅助下双侧减压治疗腰椎管狭窄症[J]. 首都医科大学学报, 2023, 44(4): 684-689.

Tao Luming, Li Dongyue, Zhang Xinuo, Su Qingjun, Hai Yong. Unilateral laminotomy for bilateral decompression assisted by unilateral biportal endoscopy in the treatment of lumbar spinal stenosis[J]. Journal of Capital Medical University, 2023, 44(4): 684-689.

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