老年椎管狭窄责任段UBE减压与开放PLIF比较△

Unilateral biportal endoscopic decompression of the responsible segment versus posterior lumbar interbody fusion for degenerative spinal stenosis in the elderly

摘要:

[目的] 比较单侧双通道内镜 （unilateral biportal endoscopy, UBE） 下责任节段椎管减压与后路腰椎间融合 （posterior lumbar interbody fusion, PLIF）治疗老年退变性腰椎椎管狭窄的临床疗效。[方法]回顾分析 2018 年 1 月—2021 年 3 月在本院收治的 65 例腰椎管狭窄症患者的临床资料，依据医患沟通结果，28 例采用 UBE 减压术，37 例采用 PLIF。比较两组围手术期、随访及影像结果。[结果]两组手术时间的差异无统计学意义（P＞0.05），UBE 切口总长度 [(2.1±0.9) cm vs (11.2±1.12) cm, P＜0.05] 、术中透视次数 [(3.3±0.8) 次 vs (5.9±1.2) 次, P＜0.05] 、术中失血量 [(36.2±10.2) ml vs (201.3±11.3) ml, P＜0.05] 、下地行走时间 [(22.7±5.1) d vs (40.2±8.5) d, P＜0.05] 、住院时间 [(7.3±2.2) d vs (11.2±3.0) d, P＜0.05] 均显著优于 PLIF 组。随访时间平均（14.1±1.1）个月，UBE 组完全负重活动时间显著早于 PLIF 组 [(4.3±2.8) 周 vs (10.6±3.4) 周, P＜0.05]。随时间推移，两组腰痛及腿痛 VAS 评分、ODI 评分均显著改善（P＜0.05），术前两组患者上述指标的差异无统计学意义（P＞0.05），术后 3 个月，UBE 组腰痛 VAS 评分 [(2.3±0.7) vs (2.8± 0.9), P＜0.05] 、腿痛 VAS 评分 [(2.5±0.6) vs (2.9±0.7), P＜0.05] 、ODI 评分 [(20.6±3.3) vs (23.4±2.9), P＜0.05] 均显著优于 PLIF 组，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，两组患者侧隐窝直径、椎管截面较术前均显著增加（P＜ 0.05）；UBE 组腰椎侧弯 Cobb 角无显著变化，而 PLIF 组显著减小。术前两组侧隐窝直径、椎管截面积、Cobb 角差异均无统计学意义（P＞0.05），末次随访时，PLIF 组 Cobb 角 [(15.7±3.3)° vs (17.8±4.6)° , P＜0.05] 显著小于 UBE 组。[结论]与传统开放 PLIF 相比， 单侧双通道内镜下责任节段椎管减压治疗老年退变性腰椎椎管狭窄手术创伤更小，短期临床效果更优。

Abstract:

[Objective] To compare the clinical outcomes of unilateral biportal endoscopic (UBE) decompression of the responsible segment versus posterior lumbar interbody fusion (PLIF) for degenerative spinal stenosis in the elderly. [Methods] A retrospective study was performed on 65 patients who underwent surgical treatment for lumbar spinal stenosis in our hospital from January 2018 to March 2021. According to doctor-patient communication, 28 patients received UBE decompression, while the other 37 patients received PLIF. The perioperative, follow-up and imaging results were compared between the two groups. [Results] Although there was no significant difference in operation time between two groups, the UBE group was suprior to the PLIF group in terms of total incision length [(2.1±0.9) cm vs (11.2±1.12) cm, P＜0.05], intraoperative fluoroscopy times [(3.3±0.8) vs (5.9±1.2) times, P＜0.05], intraoperative blood loss [(36.2±10.2) ml vs (201.3±11.3) ml, P＜0.05], ambulation time [(22.7±5.1) days vs (40.2±8.5) days, P＜0.05] and hospital stay [(7.3±2.2) days vs (11.2±3.0) days, P＜0.05]. The mean follow-up period lasted for (14.1±1.1) months, and the UBE group resumed full weight-bearing activity significantly earlier than the PLIF group [(4.3±2.8) weeks vs (10.6±3.4) weeks, P＜0.05]. The VAS scores for low back pain and leg pain, as well as ODI scores significantly improved in both groups over time postoperatively (P＜0.05), which was not statistically significant between the two groups before surgery (P＞0.05). The UBE group was significantly better than the PLIF group regarding low back pain VAS score [(2.3±0.7) vs (2.8 ±0.9), P＜0.05], leg pain VAS score [(2.5± 0.6) vs (2.9±0.7), P＜0.05], and ODI score [(20.6±3.3) vs (23.4±2.9), P＜0.05] 3 months postoperatively, while which became not statistically significant between the two groups at latest follow up (P＞0.05). Regarding imaging, the lateral recess diameter and spinal canal cross-section significantly increased in both groups at the last follow-up, compared with those before surgery (P＜0.05), the lumbar scoliotic Cobb angle remained unchanged significantly in the UBE group (P＞0.05), but decreased significantly in PLIF group (P＜0.05). There were no significant differences in lateral recess diameter, vertebral canal cross-sectional area and scoliotic Cobb angle between the two groups before surgery (P＞0.05), however, the PLIF group got significantly less scoliotic angle than the UBE group at the latest interview [(15.7±3.3)° vs (17.8±4.6)°, P＜0.05]. [Conclusion] The unilateral biportal endoscopic decompression of the responsible segment has benefits of less trauma and better short-term clinical consequences over the traditional open PLIF for degenerative lumbar spinal stenosis in the elderly.