经椎间孔镜与单侧双通道镜治疗老年腰椎椎管狭窄症△（开放获取）

Percutaneous transforaminal endoscopy versus unilateral biportal endoscopy for lumbar spinal stenosis in elderly

摘要:

［目的］ 比较经椎间孔内镜（percutaneous transforaminal endoscopy, PTE） 与单侧双通道内镜（unilateral biportal endos-copy, UBE） 治疗老年退行性腰椎椎管狭窄症（degenerative lumbar spinal stenosis, DLSS） 的临床疗效。［方法］ 回顾性分析2020年1 月—2022 年6 月接受手术治疗的单节段DLSS 72 例患者的临床资料。依据医患沟通结果，37 例采用PTE 术，35 例采用UBE 术。比较两组围手术期、随访和影像资料。［结果］ PTE 组手术时间[(63.2±11.0) min vs (81.2±10.3) min, P<0.001]、切口总长度[(1.0±0.2) cm vs (2.5±0.3) cm, P<0.001]、术中失血量[(39.2±10.9) ml vs (89.5±11.3) ml, P<0.001]、下地行走时间[(1.4±0.5) d vs(2.2±0.4) d, P<0.001]、住院时间[(9.2±1.4) d vs (11.2±2.1) d, P<0.001] 及完全负重活动时间[(62.2±9.5) d vs (71.1±10.2) d, P<0.001]均显著优于UBE 组。随时间推移，两组腰痛VAS 、腿痛VAS 和ODI 评分均显著降低（P<0.05）。术后1 d 时PTE 组的腰痛VAS 评分[(3.7±1.0) vs (4.3±1.1), P=0.018]、腿痛VAS [(2.9±0.5) vs (3.2±0.4), P=0.007]、ODI 评分[(26.6±7.7) vs (30.3±5.4), P=0.022]均显著优于UBE 组。影像方面，术后两组椎管面积较术前均显著增加（P<0.05），但随时间推移两组椎管面积均再次减少（P<0.05）。末次随访时PTE 组椎管面积显著小于UBE 组[(126.3±25.4) cm2 vs (163.7±28.6) cm2, P<0.001]。相应时间点两组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］ PTE 和UBE 两种手术方式治疗DLSS 均能取得良好临床疗效，相比UBE，PTE 手术创伤小、恢复快，术后早期腰痛、腿痛轻，但UBE 减压范围更大。

关键词:老年腰椎椎管狭窄症;经椎间孔内镜技术;单侧双通道内镜;减压术

Abstract:

[Objective] To compare the clinical outcomes of percutaneous transforaminal endoscopy (PTE) versus unilateral biportal en-doscopy (UBE) for degenerative lumbar spinal stenosis (DLSS) in the elderly. [Methods] A retrospective research was done on 72 patientswho received surgical decompression for single-segment DLSS from January 2020 to June 2022. Based on surgeon-patient discussion pre-operatively, 37 patients underwent PTE, while other 35 patients received UBE. The perioperative, follow-up and imaging data of the twogroups were compared. [Results] The PTE group proved significantly superior to the UBE group in terms of operating time [(63.2±11.0) minvs (81.2±10.3) min, P＜0.001], total length of incision [(1.0±0.2) cm vs (2.5±0.3) cm, P＜0.001], intraoperative blood loss [(39.2±10.9) ml vs(89.5±11.3) ml, P＜0.001], postoperative walk time [(1.4±0.5) days vs (2.2±0.4) days, P＜0.001], hospitalization time [(9.2±1.4) days vs (11.2±2.1) days, P＜0.001], and time to recover full weight-bearing activity [(62.2±9.5) days vs (71.1±10.2) days, P＜0.001]. The VASs for lowerback pain and leg pain, as well as ODI scores were significantly decreased in both groups over time (P＜0.05). The PTE group was signifi-cantly better than the UBE group a day postoperatively regarding to VAS score for back pain [(3.7±1.0) vs (4.3±1.1), P=0.018], VAS for legpain [(2.9±0.5) vs (3.2±0.4), P=0.007], and ODI score [(26.6±7.7) vs (30.3±5.4), P=0.022], despite of that the differences in abovesaidscores between the two groups became not statistically significant since then (P＞0.05). With respect of imaging, the canal area in bothgroups increased significantly postoperatively compared with those preoperatively (P＜0.05), but which in both groups decreased again overtime after surgery (P＜0.05). At the last follow-up, PTE group was significantly inferior to the UBE group in canal aera [(126.3±25.4) cm2 vs(163.7±28.6) cm2, P＜0.001]. There were no statistically significant differences in intervertebral space height and lumbar lordosis between the two groups at any time points accordingly (P＞0.05). [Conclusion] Both PTE and UBE can achieve good clinical efficacy in the treat-ment of DLSS. By comparison, PTE has benefits of less trauma, faster recovery, and less early postoperative low back pain and leg pain, butUBE get a wider range of decompression.

Key words:elderly; lumbar spinal stenosis; percutaneous transforaminal endoscopy; unilateral biportal endoscopy; decompression