单侧双通道与单通道内镜下单侧椎板切开双侧减压治疗腰椎管狭窄症

doi:10.3760/cma.j.cn121113-20220524-00299

科研成果详情

题名	单侧双通道与单通道内镜下单侧椎板切开双侧减压治疗腰椎管狭窄症
其他题名	Unilateral laminotomy for bilateral decompression under unilateral biportal endoscopy and uniportal endoscopy to treat lumbar spinal stenosis
作者	胡宇童 1,2; 徐浩严 3; 杨东方 2; 付豪 1,2; 滕红林4; 许卫兵 2
发表日期	2023-01-16
发表期刊	中华骨科杂志影响因子和分区
语种	中文
原始文献类型	Periodical
关键词	脊柱腰椎管狭窄减压椎板切除术
其他关键词	Spine ; Spinal stenosis ; Laminectomy ; Decompression
摘要	目的:比较单侧双通道内镜（unilateral biportal endoscopy，UBE）与单通道内镜（uniportal endoscopy，UE）下单侧椎板切开双侧减压（unilateral laminotomy for bilateral decompression，ULBD）治疗腰椎管狭窄症的临床疗效。方法:回顾性分析大连医科大学附属大连市中心医院及温州医科大学附属第一医院2020年1月至2021年6月通过UBE或UE进行ULBD治疗的82例腰椎管狭窄症的患者资料，男36例、女46例；年龄（63.3±7.5）岁（范围47~81岁）。UBE组42例，男20例、女22例，年龄（63.2±7.6）岁（范围47~81岁）；UE组40例，男16例、女24例，年龄（63.5±7.5）岁（范围48~80岁）。比较两组手术时间、住院天数和手术并发症发生率，术前、术后第1天、7天、1个月和6个月的腰腿痛视觉模拟评分（visual analogue scale，VAS）以及术前、术后1个月和6个月的Oswestry功能障碍指数（Oswestry disability index，ODI）。计算手术前后的硬膜囊面积、入路侧关节突关节切除角度、盘黄间隙减压率和骨性侧隐窝减压率。结果:所有患者均顺利完成手术。UBE组手术时间为（63.1±7.0）min、住院时间（3.9±0.9）d；UE组分别为（61.2±6.2）min、（3.7±0.9）d，差异均无统计学意义（ t=1.31， P=0.195； t=1.24， P=0.217）。UBE组的腰腿VAS由术前（7.19±0.97）分降至术后第1天（3.43±0.63）分、第7天（1.71±0.60）分、1个月（1.33±0.48）分和6个月（1.36±0.48）分（ F=352.29， P<0.001）；UE组的腰腿痛VAS评分由术前（6.85±0.89）分降至术后第1天（2.45±0.75）分、第7天（1.75±0.59）分、1个月（1.33±0.47）分和6个月（1.28±0.45）分（ F=291.44， P<0.001）。术后第1天UBE组的腰腿痛VAS高于UE组（ t=6.41， P<0.001），术后第7天两组差异无统计学意义（ t=-0.27， P=0.786）。UBE组的ODI由术前66.62%±4.98%降至术后1个月21.81%±2.61%和6个月11.62%±2.31%（ F=1991.35， P<0.001）；UE组由术前64.35%±5.16%，降至术后1个月22.85%±3.26%和6个月11.15%±2.86%（ F=1931.18， P<0.001）。术后UBE组的硬膜囊面积为（135.1±10.0）mm 2大于UE组的（120.9±10.4）mm 2（ t=6.30， P<0.001）。术后UBE组的入路侧关节突关节切除角度为69.3°±4.9°小于UE组的94.3°±4.1°（ t=-25.00， P<0.001）。两组同侧的盘黄间隙减压率分别为39.0%±3.0%和38.7%±3.3%（ t=1.52， P=0.134），对侧分别为41.6%±3.3%和22.8%±3.2%（ t=26.32， P<0.001）。两组同侧的骨性侧隐窝减压率分别为70.0%±4.8%和59.3%±3.9%（ t=15.64， P<0.001），对侧分别为73.0%±3.4%和48.4%±4.3%（ t=28.86， P<0.001）。UBE组同侧盘黄间隙减压率及骨性侧隐窝减压率与对侧的差异无统计学意义（ t=-1.40， P=0.174； t=-1.72， P=0.096），而UE组同侧的盘黄间隙减压率及骨性侧隐窝减压率均大于对侧（ t=28.51， P<0.001； t=13.95， P<0.001）。结论:通过UE和UBE行ULBD治疗腰椎管狭窄症均能取得良好的短期临床疗效。UB术后早期疼痛缓解优于UBE；而UBE能够更好地保留关节突关节，在影像学上减压效果更佳。
其他摘要	Objective:To compare the clinical efficacy of unilateral biportal endoscopy (UBE) and uniportal endoscopy (UE) for unilateral laminotomy for bilateral decompression (ULBD) in the treatment of lumbar spinal stenosis.Methods:Data of 82 patients with lumbar spinal stenosis treated by ULBD under UBE or UE from January 2020 to June 2021 in Dalian Central Hospital affiliated to Dalian Medical University and the First Hospital affiliated to Wenzhou Medical University were retrospectively analyzed, including 36 males and 46 females, aged 63.3±7.5 years (range, 47-81 years). According to the surgical procedure, they were divided into UBE group (42 cases), including 20 males and 22 females; aged 63.2±7.6 years (range, 47-81 years) and UE group (40 cases), including 16 males and 24 females; aged 63.5±7.5 years (range, 48-80 years). Operation time, hospital stay and surgical complications were compared between the two groups. Visual analogue scale (VAS) of low back and leg pain before surgery, 1 day, 7 d, 1 month and 6 months after surgery, and Oswestry disability index (ODI) before surgery, 1 month and 6 months after surgery were compared. Dural sac area before and after surgery, resection angle of ipsilateral facet joint, decompression rate of disc space and bone lateral recess were calculated.Results:All patients were operated successfully. In the UBE group, the operation time was 63.1±7.0 min, and the hospital stay was 3.9±0.9 d. The UE group was 61.2±6.2 min and 3.7±0.9 d, respectively ( t=1.31, P=0.195; t=1.24, P=0.217). The VAS of back and legs pain in UBE group decreased from 7.19±0.97 before operation to 3.43±0.63 points at postoperative 1 day, 1.71±0.60 at postoperative 7 d, 1.33±0.48 at postoperative 1 month and 1.36±0.48 points at postoperative 6 months ( F=352.29, P<0.001). The VAS score of the UE group decreased from 6.85±0.89 points before operation to 2.45±0.75 points at postoperative 1 day, 1.75±0.59 points at postoperative 7 d, 1.33±0.47 points at postoperative 1 month and 1.28±0.45 points at postoperative 6 months ( F=291.44, P<0.001). The VAS of low back and leg pain was higher in the UBE group than in the UE group at 1 day postoperatively ( t=6.41, P<0.001), and the difference was not statistically significant at 7 d postoperatively ( t=-0.27, P=0.786). The ODI of UBE group decreased from 66.62%±4.98% before operation to 21.81%±2.61% at postoperative 1 month and 11.62%±2.31% at postoperative 6 months ( F=1991.35, P<0.001). The ODI score of UE group decreased from 64.35%±5.16% before operation to 22.85%±3.26% at postoperative 1 month and 11.15%±2.86% at postoperative 6 months ( F=1931.18, P<0.001). The postoperative dural sac area of the UBE and UE groups was 135.1±10.0 mm 2 and 120.9±10.4 mm 2 ( t=6.30, P<0.001). The resection angle of ipsilateral facet joint was 69.3°±4.9° and 94.3°±4.1° in the two groups, respectively, with a statistically significant difference ( t=-25.00, P<0.001). The decompression rate of ipsilateral disk-flavum space was 39.0%±3.0% and 38.7%±3.3% in the two groups ( t=1.52, P=0.314). On the contralateral side was 41.6%±3.3% and 22.8%±3.2% ( t=26.32, P<0.001), respectively. The ipsilateral osseous side fossa decompression rate in the two groups were 70.0%±4.8% and 59.3%±3.9% ( t=15.64, P<0.001), the contralateral were 73.0%±3.4% and 48.4%±4.3% ( t=28.86, P<0.001). There was no significant difference in the decompression rate of ipsilateral disco-flavum space or bony lateral recess between the UBE group and the contralateral group ( t=-1.40, P=0.174; t=-1.72, P=0.096), while the decompression rate of discoflavum space and bony side recess on the ipsilateral side of UE group were higher than those on the contralateral side ( t=28.51, P<0.001; t=13.95, P<0.001). Conclusion:Both UE-ULBD and UBE-ULBD have good short-term clinical efficacy in patients with lumbar spinal stenosis. UB is better than UBE in early postoperative pain relief. However, UBE shows better imaging performance in decompression effect and better retention of facet joints.
ISSN	0253-2352
卷号	43 期号:2 页码:89-96
DOI	10.3760/cma.j.cn121113-20220524-00299
页数	8
收录类别	万方 ; CSCD ; SCOPUS ; 维普 ; ISTIC ; 北大核心 ; ISTIC
URL	查看原文
SCOPUSEID	2-s2.0-85168700522
引用统计
文献类型	期刊论文
条目标识符	https://kms.wmu.edu.cn/handle/3ETUA0LF/173106
专题	第二临床医学院、附属第二医院、育英儿童医院_外科学_脊柱外科附属第一医院
作者单位	1.大连医科大学研究生院，大连　116044; 2.大连医科大学附属大连市中心医院脊柱外科，大连　116033; 3.丹东市人民医院骨科，丹东　118002; 4.温州医科大学附属第一医院脊柱外科，温州　325015
推荐引用方式 GB/T 7714	胡宇童,徐浩严,杨东方,等. 单侧双通道与单通道内镜下单侧椎板切开双侧减压治疗腰椎管狭窄症[J]. 中华骨科杂志,2023,43(2):89-96.
APA	胡宇童, 徐浩严, 杨东方, 付豪, 滕红林, & 许卫兵. (2023). 单侧双通道与单通道内镜下单侧椎板切开双侧减压治疗腰椎管狭窄症. 中华骨科杂志, 43(2), 89-96.
MLA	胡宇童,et al."单侧双通道与单通道内镜下单侧椎板切开双侧减压治疗腰椎管狭窄症".中华骨科杂志 43.2(2023):89-96.