两种术式治疗腰椎管狭窄症的临床比较△

Comparison of two surgical procedures in the treatment of lumbar spinal stenosis

摘要:

[目的]比较采用单边双通道内镜（unilateral biportal endoscopy, UBE）与经椎间孔腰椎间融合术（transforaminal lum- bar interbody fusion, TLIF） 治疗腰椎管狭窄症 （lumbar spinal stenosis, LSS） 的临床疗效。[方法] 回顾性分析 2019 年 11 月— 2021 年 7 月手术治疗的 45 例 LSS 患者的临床资料，根据医患沟通结果，20 例采用 UBE 术，25 例采用 TLIF 术。比较两组围手术期、随访及影像学结果。[结果]两组手术时间、切口愈合等级的差异均无统计学意义（P＞0.05），但是，UBE 组切口总长度 [(2.2±2.2)cm vs (10.2±1.7)cm, P＜0.05]、术中失血量 [(35.0±21.3)ml vs (472.0±171.4)ml, P＜0.05]、术中透视次数 [(6.1±0.9)次 vs (10.0± 2.3)次，P＜0.05]、下地行走时间 [(1.5±0.7)d vs (3.7±1.0)d，P＜0.05]、住院时间 [(13.4±3.2)d vs (17.8±7.2)d, P＜0.05] 均显著优于 TLIF 组。所有患者均获随访 12 个月以上，UBE 组恢复完全负重活动时间显著早于 TLIF 组 [(70.3±11.9)d vs (90.4±13.4)d, P＜0.05]。随时间推移，两组患者腰腿痛 VAS 评分、腿痛 VAS 评分、ODI 和 JOA 评分均显著改善。术后 1 个月 UBE 组腰痛 VAS 评分 [(2.5±0.5) vs (4.2±0.9), P＜0.05] 、ODI 评分 [(11.2±5.0) vs (18.8±9.0) , P＜0.05]、JOA 评分 [(20.9±3.5) vs (17.5±2.8), P＜0.05] 均显著优于 TLIF 组。 末次随访时，两组间上述指标的差异均无统计学意义 （P＞0.05）。影像方面，与术前相比，术后两组患者椎管面积均显著增加 （P＜0.05）；术后 UBE 组椎管面积显著小于 TLIF 组 [(191.6±33.8)cm² vs (244.6±21.9)cm² , P＜0.05]。两组患者椎间隙高度和腰椎前凸角术前术后均无显著变化（P＞0.05），相应时间点两组间椎间隙高度和腰椎前凸角的差异均无统计意义（P＞0.05）。[结论] UBE 和 TLIF 两种手术方式治疗 LSS 均能取得良好临床疗效，相比 TLIF 术，UBE 手术创伤小，恢复快，术后早期腰痛轻，特别适合累及节段较少的 LSS。

Abstract:

[Objective] To compare the clinical outcomes of unilateral biportal endoscopy (UBE) versus traditional transforaminal lum- bar interbody fusion (TLIF) for lumbar spine stenosis (LSS). [Methods] A retrospective study were done on 45 patients who received surgical treatment for LSS from November 2019 to July 2021. According to doctor-patient communication, 20 patients received UBE, while the other 25 patients received TLIF. The perioperative period, follow-up and imaging documents were compared between the two groups. [Results] Al- though there were no significant differences in operation time and incision healing grade between the two groups (P＞0.05), the UBE group proved significantly superior to the TLIF group in terms of total incision length [(2.2±2.2)cm vs (10.2±1.7)cm, P＜0.05], intraoperative blood loss [(35.0±21.3)ml vs (472.0±171.4)ml, P＜0.05], intraoperative fluoroscopy times [(6.1±0.9)times vs (10.0 ±2.3)times, P＜0.05], the postoper- ative ambulation time [(1.5±0.7)days vs (3.7±1.0)days, P＜0.05] and hospital stay [(13.4±3.2)days vs (17.8±7.2)days, P＜0.05]. All patients in both groups were followed up for more than 12 months, and the UBE group resumed full weight-bearing activities significantly earlier than the TLIF group [(70.3±11.9)days vs (90.4±13.4)days, P＜0.05]. The VAS scores for back pain and leg pain, as well as ODI and JOA scores sig- nificantly improved in both groups with time (P＜0.05). The UBE group was significantly better than the TLIF group in terms of VAS score for low back pain [(2.5±0.5) vs (4.2±0.9), P＜0.05], ODI score [(11.2±5.0) vs (18.8±9.0), P＜0.05], JOA score [(20.9±3.5) vs (17.5±2.8), P＜0.05] a month postoperatively. However, there were no significant differences in the above indexes between the two groups at the last follow-up (P＞ 0.05). Regarding imaging, the spinal canal area increased significantly in both groups postoperatively compared with those preoperatively (P＜0.05), which in UBE group was significantly smaller than that in TLIF group after operation [(191.6±33.8)cm² vs (244.6±21.9)cm² , P＜0.05]. Moreover, there were no significant changes in intervertebral height and lumbar lordosis angle in both groups before and after surgery (P＞ 0.05), and there were no statistically significant differences between the two groups in intervertebral space height and lumbar lordosis angle at any time points accordingly (P＞0.05). [Conclusion] Both UBE and TLIF do achieve good clinical outcomes in the treatment of LSS. By comparison, the UBE takes advantages of less trauma, faster recovery and less early postoperative lumbago over the TLIF, which is especially suitable for LSS with fewer segments involved.