摘要
[目的]比较单边双通道脊柱内镜(unilateral biportal endoscopy,UBE)减压与后路腰椎椎间融合术(posterior lumbar interbody fusion,PLIF)治疗双节段腰椎管狭窄症(lumbar spinal stenosis,LSS)的临床疗效。[方法]回顾分析2017年1月—2022年1月手术治疗双节段LSS的60例患者资料。根据术前医患沟通结果,30例采用UBE减压,30例采用PLIF。比较两组围手术期、随访及影像资料。[结果]UBE组手术时间[min,(102.7±7.8)vs(121.3±14.7),P<0.001]、切口长度[cm,(5.0±0.1)vs(8.5±0.8),P<0.001]、术中失血量[mL,(79.7±9.8)vs(695.3±61.9),P<0.001]、术中透视次数[次,(4.6±0.7)vs(6.2±0.8),P<0.001]、术后24 h引流量[mL,(66.9±6.1)vs(145.9±24.2),P<0.001]、下地行走时间[d,(1.9±1.3)vs(3.6±0.9),P<0.001]、住院天数[d,(7.8±1.8)vs(10.0±2.1),P<0.001]均显著优于PLIF组。随访时间平均(12.6±0.7)个月,随时间推移,两组患者腰腿痛VAS评分及ODI评分均显著降低(P<0.05),UBE组术后7 d腰痛VAS评分[分,(3.4±0.7)vs(4.2±1.0),P<0.001]及术后1个月ODI[%,(28.8±4.0)vs(33.1±4.8),P<0.001]显著优于PLIF组,术后3个月、末次随访时,上述指标差异均无统计学意义(P>0.05)。影像方面,末次随访时,UBE组责任节段硬膜囊面积[mm^(2),(114.2±8.7)vs(123.7±6.8),P<0.001]及椎间隙高度[mm,(10.8±0.8)vs(11.6±0.7),P<0.001]明显小于PLIF组,但前者腰椎屈伸活动度明显优于后者[°,(27.6±6.3)vs(15.2±4.0),P<0.001]。[结论]针对稳定性良好的双节段LSS患者,采用UBE减压可取得良好临床疗效,相较于PLIF,UBE手术创伤小、风险低、早期腰痛轻、功能恢复快、对腰椎屈伸活动度影响小。
[Objective]To compare the clinical efficacy of unilateral biportal endoscopy(UBE)decompression versus posterior lumbar interbody fusion(PLIF)in the treatment of double-segment lumbar spinal stenosis(LSS).[Methods]A retrospective research was conducted on 60 patients who underwent surgical treatment for double-segment LSS from January 2017 to January 2022.According to the preoperative doctor-patient communication,30 patients received UBE decompression,while other 30 patients underwent PLIF.The perioperative,follow-up and imaging data of the two groups were compared.[Results]The UBE group proved significantly superior to the PLIF group in terms of operating time[min,(102.7±7.8)vs(121.3±14.7),P<0.001],incision length[cm,(5.0±0.1)vs(8.5±0.8),P<0.001],intraoperative blood loss[mL,(79.7±9.8)vs(695.3±61.9),P<0.001],intraoperative fluoroscopy times[(4.6±0.7)vs(6.2±0.8),P<0.001],drainage volume within 24 hours after operation[mL,(66.9±6.1)vs(145.9±24.2),P<0.001],postoperative ambulation time[days,(1.9±1.3)vs(3.6±0.9),P<0.001]and hospital stay[days,(7.8±1.8)vs(10.0±2.1),P<0.001].As time elapsed during follow-up period lasted for(12.6±0.7)months in a mean,the VAS scores for low back and leg pain,as well as ODI score in both groups decreased significantly(P<0.05).The UBE group was significantly better than the PLIF group in the VAS score for low back pain 7 days after surgery[points,(3.4±0.7)vs(4.2±1.0),P<0.001]and the ODI 1 month postoperatively[%,(28.8±4.0)vs(33.1±4.8),P<0.001],despite of no statistically significant differences in the above indicator between the two groups at 3 months after surgery and the last follow-up(P>0.05).As for imaging,the UBE group was significantly smaller than the PLIF group regarding the dural sac area of the responsible segment[mm^(2),(114.2±8.7)vs(123.7±6.8),P<0.001]and the intervertebral space height[mm,(10.8±0.8)vs(11.6±0.7),P<0.001]at the last follow-up.However,the former proved significantly superior to the latter in lumbar extension-flexion mobility[°,(27.6±6.3)vs(15.2±4.0),P<0.001].[Conclusion]The UBE decompression does achieve good clinical outcome for double-segment LSS with good stability,takes advantages of less trauma,lower risk,less early low back pain,faster functional recovery,and less impact on the lumbar mobility over PLIF.
作者
秦晓东
朱建炜
朱小建
丁正美
曹建华
QIN Xiao-dong;ZHU Jian-wei;ZHU Xiao-jian;DING Zheng-mei;CAO Jian-hua(Affiliated Hospital,Nantong University,Nantong 226001,Jiangsu,China;Nantong Fourth People's Hospital,Nantong 226005,Jiangsu,China)
出处
《中国矫形外科杂志》
北大核心
2025年第23期2134-2139,共6页
Orthopedic Journal of China
关键词
双节段腰椎管狭窄症
单边双通道内镜
减压术
后路腰椎椎间融合术
double-segment lumbar spinal stenosis
unilateral biportal endoscopy
decompression
posterior lumbar interbody fusion
