内镜减压与后路扩大融合治疗腰椎邻椎病的比较△（开放获取）

Endoscopic decompression versus extended posterior fusion for adjacent spondylosis secondary to lumbar fusion

摘要:

[目的] 比较单侧双通道脊柱内镜 （unilateral biportal endoscopic, UBE） 与后路腰椎间融合术 （posterior lumbar inter- body fusion, PLIF） 治疗腰椎融合后邻椎病的临床疗效。[方法] 2021 年 1 月—2022 年 9 月对 57 例腰椎融合术后邻椎病患者行手术治疗，依据术前医患沟通结果，31 例行 UBE 减压术治疗，26 例行扩大 PLIF 手术治疗，比较两组患者的围术期及相关随访资料。[结果]两组患者均顺利完成手术，两组各 1 例发生神经根外膜撕裂，出现术后下肢一过性疼痛，给予激素、脱水等对症治疗。减压组在手术时间 [(84.1±11.5) min vs (149.2±11.4) min, P＜0.05]、切口总长度 [(2.3±0.4) cm vs (12.3±1.5) cm, P＜0.05]、术中失血量 [(27.9±4.0) ml vs (266.5±16.0) ml, P＜0.05]、术中透视次数 [(3.1±0.5) 次 vs (5.4±0.5) 次, P＜0.05]、下地时间 [(2.5±0.5) d vs (3.6± 0.6) d, P＜0.05]、住院时间 [(5.4±0.6) d vs (9.6±0.6) d, P＜0.05]、完全负重活动时间 [(49.7±3.3) d vs (60.2±1.1) d, P＜0.05] 均显著优于融合组。随时间推移，两组患者的腰、腿痛 VAS 及 ODI 评分均显著改善（P＜0.05）。影像方面，术后两组患者的椎管面积及侧隐窝矢状径较术前均显著增加（P＜0.05），两组腰椎前凸角无显著变化（P＞0.05）。末次随访时，减压组的椎管面积 [(160.3±6.6) mm² vs (179.9±1.8) mm² , P＜0.05]、侧隐窝矢状径 [(3.9±.01) mm vs (4.2±0.1) mm, P＜0.05] 均显著小于融合组。[结论] 单侧双通道脊柱内镜减压治疗腰椎邻椎病，安全可行，创伤小，不破坏腰椎后方张力带结构，恢复快，临床效果好。

Abstract:

[Objective] To compare the clinical efficacy of decompression by unilateral biportal endoscopy (UBE) versus extended posterior lumbar interbody fusion (PLIF) for adjacent spondylosis secondary to lumbar fusion. [Methods] From January 2021 to September 2022, 57 patients underwent surgical treatment for adjacent spondylosis after lumbar fusion. According to preoperative doctor-patient discussion, 31 patients received UBE decompression, while other 26 patients received extended PLIF. The documents regarding perioperative period and followup were compared between the two groups. [Results] All patients in both groups had corresponding surgical procedures performed smoothly, despite that 1 case in each group suffered from membrane tear of the outer nerve root with transient pain of lower extremity after surgery, which were treated by symptomatic treatment such as hormone and dehydration. The decompression group proved significantly superior to the extended fusion group in terms of operation time [(84.1±11.5) min vs (149.2±11.4) min, P＜0.05], total length of incision [(2.3± 0.4) cm vs (12.3±1.5) cm, P＜0.05], intraoperative blood loss [(27.9±4.0) ml vs (266.5±16.0) ml, P＜0.05], intraoperative fluoroscopy [(3.1± 0.5) times vs (5.4±0.5) times, P＜0.05], postoperative ambulation time [(2.5±0.5) days vs (3.6±0.6) days, P＜0.05], hospital stay [(5.4±0.6) days vs (9.6±0.6) days, P＜0.05], in addition, the former recovered full weight-bearing activity significantly earlier than the latter [(49.7±3.3) days vs (60.2±1.1) days, P＜0.05]. The VAS for lumbago and leg pain, as well as ODI scores were significantly improved in both groups over time (P＜0.05). In terms of imaging, the vertebral canal area and lateral recess sagittal diameter were significantly increased after surgery in both groups (P＜0.05), whereas the lumbar lordosis remained unchanged remarkably in both of them (P＞0.05). However, the decompression group was significantly less than the extended fusion group in terms of the spinal canal area [(160.3±6.6) mm² vs (179.9±1.8) mm² , P＜0.05] and the lateral recess sagittal diameter [(3.9±.01) mm vs (4.2±0.1) mm, P＜0.05] at the last follow-up. [Conclusion] The decompression under unilateral biportal endoscopy is a safe, feasible, less traumatic technique without destroy to the posterior tension band structure of the lumbar spine, does get fast recovery, and good clinical consequence.