腰椎管狭窄症单侧双通道内镜下单侧与双侧减压比较△

Comparison of unilateral and bilateral decompression under unilateral biportal endoscopy for lumbar spinal stenosis

摘要:

［目的］比较单侧症状的中重度腰椎管狭窄症（lumbar spinal stenosis, LSS）单侧双通道内镜（unilateral biportal endo- scopic, UBE） 下单侧与双侧减压的临床疗效。［方法］ 回顾性分析 2020 年 3 月—2021 年 2 月采用 UBE 技术治疗单侧症状的中重度 LSS 120 例患者的临床资料。根据医患沟通结果，60 例采用单侧减压，60 例采用双侧减压。比较两组围手术期、随访及影像资料。［结果］所有患者手术顺利，均无严重手术并发症。单侧组手术时间短于双侧组（P<0.05）；其他围手术期指标两组差异均无统计学意义 （P>0.05）。随时间推移，两组 VAS 评分及 ODI 指数均显著降低 （P<0.05），而 JOA 评分显著增加 （P< 0.05），术前两组 VAS 评分、ODI 指数、JOA 评分的差异均无统计学意义（P>0.05），术后相应时间点双侧组上述评分均显著优于单侧组 （P<0.05）。影像学方面，术后即刻、末次随访时两组椎管面积均较术前均显著增加 （P<0.05），但两组椎间隙高度、 局部腰椎前凸角均无显著变化 （P>0.05）。术前两组间上述影像指标的差异均无统计学意义 （P>0.05），术后即刻及末次随访时，双侧组的椎管面积显著大于单侧组 （P<0.05），两组椎间隙高度、局部腰椎前凸角的差异均无统计学意义 （P>0.05）。［结论］ UBE 单侧或双侧减压均可有效治疗单侧症状的中重度 LSS，相比之下，双侧减压可更有效扩大硬膜囊面积，临床效果更佳。

Abstract:

[Objective] To compare the clinical efficacy of unilateral and bilateral decompression under unilateral biportal endoscopy (UBE) for moderate and severe lumbar spinal stenosis (LSS) with unilateral symptoms. [Methods] A retrospective study was conducted on 120 patients who received decompression by UBE for moderate and severe LSS in our department from March 2020 to February 2021. Ac- cording to preoperative doctor- patient communication, 60 patients underwent unilateral decompression, while the remaining 60 patients had bilateral decompression performed. The data regarding to perioperative period, follow-up and radiographs were compared between the two groups. [Results] All patients were operated on smoothly without serious complications. Although the unilateral group consumed signifi- cantly less operation time than the bilateral group (P＜0.05) , there was no significant difference in other perioperative indicators between the two groups (P＞0.05) . The VAS and ODI scores decreased significantly (P＜0.05) , while the JOA score increased significantly in both groups over time (P＜0.05) . The bilateral group proved significantly superior to the unilateral group in terms of abovementioned scores at 7 days, 3 months after operation and the latest follow-up (P＜0.05) . Radiographically, the dural sac area significantly increased immediately after operation and at the latest follow-up compared with that preoperatively in both groups (P＜0.05) , which in bilateral group was better than the unilateral group (P＜0.05) . However, the intervertebral space height and local lumbar lordosis angle remained unchanged in both groups postoperatively by comparison with those preoperatively (P＞0.05) , which were not statistically significant between the two groups at matching time points (P＞0.05) . [Conclusion] Both unilateral and bilateral decompression by using UBE do effectively treat moderate and severe LSS with unilateral symptoms. By contrast, the bilateral decompression does more effectively expand the dural sac area with better clinical outcomes over the unilateral decompression.