[1]李业成,王占朝△.单侧双通道内镜技术治疗腰椎管狭窄症的早期疗效分析[J].中国中医骨伤科杂志,2024,32(06):80-84.[doi:10.20085/j.cnki.issn1005-0205.240616]
　LI Yecheng,WANG Zhanchao.Preliminary Clinical Efficacy of Unilateral Biportal Endoscopic in the Treatment of Lumbar Spinal Stenosis[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2024,32(06):80-84.[doi:10.20085/j.cnki.issn1005-0205.240616]
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单侧双通道内镜技术治疗腰椎管狭窄症的早期疗效分析()
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第32卷
期数:
2024年06期
页码:
80-84
栏目:
临床报道
出版日期:
2024-06-15

文章信息/Info

Title:
Preliminary Clinical Efficacy of Unilateral Biportal Endoscopic in the Treatment of Lumbar Spinal Stenosis
文章编号:
1005-0205(2024)06-0080-05
作者:
李业成1; 王占朝1△
1上海健康医学院附属崇明医院(上海,202150)
Author(s):
LI Yecheng1; WANG Zhanchao1△
1Chongming Hospital Affiliated to Shanghai University of Medicine & Health Sciences,Shanghai 202150,China.
关键词:
单侧双通道内镜;  腰椎管狭窄症;  临床疗效
Keywords:
unilateral biportal endoscopic;  lumbar spinal stenosis;  clinical efficacy
分类号:
R681.5
DOI:
10.20085/j.cnki.issn1005-0205.240616
文献标志码:
B
摘要:
目的:探讨单侧双通道内镜(UBE)治疗腰椎管狭窄症的早期临床疗效。方法:纳入自2021年5月至2023年5月诊治的38例单节段腰椎管狭窄症患者。记录患者术前及术后第1天、第1个月、第3个月、第6个月视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)评分、改良MacNab标准疗效评价、术后并发症、手术时间、术后开始下地活动时间,并在X线片上测量术前及末次随访时的椎间盘高度指数(DHI)、椎间孔高度指数(FHI)、滑脱百分比和椎间角(IVA),评估脊柱稳定性。结果:38例患者均随访3～6个月,平均(4.2±1.8)个月。术前与术后各时间点VAS评分及ODI评分差异有统计学意义(P<0.05),手术时间为136.3～162.7 min,平均为(128.4±7.4)min; 术后开始下地活动时间为4.6～1.2 d,平均为(4.2±1.3)d; 术后发生脑脊液漏1例,无切口感染及神经根损伤。末次随访时改良MacNab疗效评定标准优24例,良12例,可2例,差0例,优良率 94.7%。与术前比较,术后第6个月影像学检查数据显示椎间角、滑脱百分比、椎间盘高度指数及椎间孔高度指数差异无统计学意义(P>0.05)。结论:单侧双通道内镜治疗的早期随访临床疗效显著,可以安全有效地进行椎管减压,具有创伤小、恢复快、避免脊柱融合且不影响脊柱稳定性的优势。
Abstract:
Objective:To investigate the preliminary clinical efficacy of unilateral biportal endoscopic(UBE)in the treatment of lumbar spinal stenosis.Methods:38 patients with single-segment lumbar spinal stenosis treated from May 2021 to May 2023 were included.The visual analogue scale(VAS)and Oswestry disability index(ODI)scores were evaluated in all patients preoperatively,postoperatively at 1 d,1 month,3 months and 6 months.The modified MacNab criteria,the postoperative complications,the operation time and the postoperative ambulatory time were recorded.Plain radiographs obtained preoperatively and 6 months postoperatively were compared to analyze the intervertebral angle(IVA),percentage of slip,disc height index(DHI),and foraminal height index(FHI).Results:38 patients were enrolled in follow-up for 3 to 6 months,an average of(4.2±1.8)months.There was significant difference in VAS score and ODI score between preoperative and postoperative time points(P<0.05).The operation time was 136.3162.7 min,an average of(128.4±7.4)min,and the postoperative ambulatory time was 4.61.2 d,an average of(4.2±1.3)d.There was one case of postoperative cerebrospinal fluid leakage,no incision infection and nerve root injury.At the last follow-up,the modified MacNab criteria were excellent in 24 patients,good in 12,fair in 2,poor in 0,the excellent and good rate was 94.7%.The IVA,the percentage of slip,the DHI and the FHI at 6-months follow-up were not statistically significant(P>0.05).Conclusion:The early follow-up clinical efficacy of UBE is significant,which can safely and effectively perform spinal canal decompression.It has the advantages of minimal trauma,fast recovery,avoiding spinal fusion,and not affecting spinal stability.

参考文献/References:

[1] ARABMOTLAGH M,SELLEI R M,VINAS-RIOS J M,et al.Classification and diagnosis of lumbar spinal stenosis[J].Orthopade,2019,48(10):816-823.
[2] BYDON M,ALVI M A,GOYAL A.Degenerative lumbar spondylolisthesis:definition,natural history,conservative management,and surgical treatment[J].Neurosurg Clin N Am,2019,30(3):299-304.
[3] KOENDERS N,RUSHTON A,VERRA M L,et al.Pain and disability after first-time spinal fusion for lumbar degenerative disorders:a systematic review and meta-analysis[J].Eur Spine J,2019,28(4):696-709.
[4] KIM J E,CHOI D J,PARK E J J,et al.Biportal endoscopic spinal surgery for lumbar spinal stenosis[J].Asian Spine J,2019,13(2):334-342.
[5] 李业成,张巍.经皮椎体后凸成形术联合单侧双通道内镜技术治疗脊柱外伤后凸疗效分析[J].中国中医骨伤科杂志,2022,30(10):52-56.
[6] HAMASAKI T,TANAKA N,KIM J,et al.Biomechanical assessment of minimally invasive decompression for lumbar spinal canal stenosis:a cadaver study[J].J Spinal Disord Tech,2009,22(7):486-491.
[7] YIN G,HUANG B,WANG C,et al.Therapeutic effects of full endoscopic spine surgery via transforaminal approach in elderly patients with lumbar spinal stenosis:a retrospective clinical study[J].Acta Orthop Traumatol Turc,2021,55(2):166-170.
[8] TANG S,MOK T N,HE Q,et al.Comparison of clinical and radiological outcomes of full-endoscopic versus microscopic lumbar decompression laminectomy for the treatment of lumbar spinal stenosis:a systematic review and meta-analysis[J].Ann Palliat Med,2021,10(10):10130-10146.
[9] LEE C W,YOON K J,KIM S W.Percutaneous endoscopic decompression in lumbar canal and lateral recess stenosis-the surgical learning curve[J].Neurospine,2019,16(1):63-71.
[10] KIM J,HEO D H,LEE D C,et al.Biportal endoscopic unilateral laminotomy with bilateral decompression for the treatment of cervical spondylotic myelopathy[J].Acta Neurochir(Wien),2021,163(9):2537-2543.
[11] WIDMER J,CORNAZ F,SCHEIBLER G,et al.Biomechanical contribution of spinal structures to stability of the lumbar spine-novel biomechanical insights[J].Spine J,2020,20(10):1705-1716.
[12] 周劲松,李业成.单侧双通道内镜与椎板开窗髓核摘除术治疗脱垂游离型腰椎间盘突出症疗效比较[J].中国骨与关节杂志,2023,12(4):290-295.
[13] KIM J E,CHOI D J,PARK E J.Risk factors and options of management for an incidental dural tear in biportal endoscopicspine surgery[J].Asian Spine J,2020,14(6):790-800.

备注/Memo

备注/Memo:
△通信作者 E-mail:477530342@qq.com
更新日期/Last Update: 2024-06-15