腰椎管狭窄症两种内镜减压术比较

Comparison of two endoscopic decompression procedures for lumbar spinal stenosis

摘要:

[目的]比较两种内镜减压术治疗腰椎管狭窄症疗效。[方法]回顾性分析 2018 年 5 月—2021 年 5 月在安徽医科大学第二附属医院及合肥市第三人民医院内镜手术治疗腰椎管狭窄症 213 例患者的临床资料。按照医患沟通结果，132 例采用单侧双通道内镜下椎管减压术（unilateral biportal endoscopy, UBE），81 例采用全内镜可视化椎孔成形术减压术（endoscopic forami- noplasty and decompression, EFD），比较两组围手术期、随访及影像结果。[结果] 两组患者均顺利完成手术，UBE 组术中硬膜撕裂 [1 (0.8%) vs 5 (6.2%), P＜0.05] 和神经根损伤 [2 (1.5%) vs 6 (7.4%), P＜0.05] 显著均少于 EFD 组，且术中射线暴露时间 [(1.1± 0.1) min vs (3.3±0.6) min, P＜0.05]，显著短于 EFD 组。两组手术时间、术后感染率、下地行走时间、住院时间的差异均无统计学意义 （P＞0.05）。两组患者均获随访 12 个月以上，两组恢复完全负重活动时间的差异无统计学意义 （P＞0.05）。与术前相比， 末次随访时两组患者术后腰痛 VAS 评分、腿痛 VAS 评分和 ODI 评分均显著减少 （P＜0.05），相应时间点，两组间腰痛 VAS 评分、腿痛 VAS 评分、ODI 评分的差异均无统计学意义（P＞0.05）。影像方面，与术前相比，术后 3 个月及末次随访时，两组患者患椎椎间隙高度、侧隐窝矢状径、中央椎管矢状径、腰椎前凸角（L₁~S₁ Cobb 角）均显著增加（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），但是术后 UBE 组侧隐窝矢状径 [(12.0±3.7) mm vs (9.8±2.8) mm, P＜0.001] 和中央椎管矢状径 [(15.7±3.8) mm vs (9.8±2.1) mm, P＜0.001] 显著大于 EFD 组。相应时间点，两组间患椎椎间隙高度、腰椎前凸角的差异均无统计学意义（P＞0.05）。[结论]UBE 术能改善腰椎管狭窄患者的症状，临床效果显著，特别是在解决腰椎管双侧狭窄及重度狭窄时，优于单侧椎间孔镜技术。

关键词:椎管狭窄;微创手术;单侧双通道内镜术;内镜椎孔成形术减压术

Abstract:

[Objective] To compare the clinical efficacy of two kinds of endoscopic decompression in the treatment of lumbar spinal ste- nosis. [Methods] A retrospective study was conducted on 213 patients who received endoscopic surgery for lumbar spinal stenosis in The Second Affiliated Hospital of Anhui Medical University and the Third People's Hospital of Hefei City from May 2018 to May 2021. Accord- ing to doctor-patient communication, 132 patients underwent unilateral biportal endoscopy (UBE), while the other 81 patients were treated with endoscopic foraminoplasty and decompression (EFD). The perioperative period, follow- up and imaging data of the two groups were compared. [Results] All the patients in both groups were operated on successfully. The UBE group proved significantly superior to the EFD group in terms of dural tear [1 (0.8%) vs 5 (6.2%), P＜0.05] and nerve root injury [2 (1.5%) vs 6 (7.4%), P＜0.05], as well as intraoperative ra- diation exposure time [(1.1±0.1) min vs (3.3±0.6) min, P＜0.05], nevertheless, there were no significant differences in operation time, postop- erative infection rate, postoperative walking time and hospital stay between the two groups (P＞0.05). All of them in both groups were fol- lowed up for more than 12 months, without a significant difference in the time to return to full weight-bearing activities between the two groups (P＞0.05). The VAS scores for both low back pain and leg pain, and ODI score significantly decreased in both groups at the latest fol- low-up compared with those preoperatively (P＜0.05), which proved not significantly different between the two groups at any corresponding time points (P＞0.05). Radiographically, compared with those preoperatively the height of involved vertebral space, sagittal diameter of later- al recess, sagittal diameter of central spinal canal and lumbar lordosis angle (L₁~S₁ Cobb angle) were significantly increased in both groups 3 months after surgery and at the last follow-up (P＜0.05). Although there was no significant difference in the abovesaid imaging indexes be- tween the two groups before surgery (P＞0.05), the UBE group got significantly greater sagittal diameter of lateral recess [(12.0±3.7) mm vs (9.8±2.8) mm, P＜0.001] and sagittal diameter of central spinal canal [(15.7±3.8) mm vs (9.8±2.1) mm, P＜0.001] than the EFD group post- operatively. However, there were no statistically significant differences in the height of intervertebral space and lumbar lordosis angle be- tween the two groups at any time points accordingly (P＞0.05). [Conclusion] The UBE does improve the symptoms of patients with lumbar spinal stenosis and achieve satisfactory clinical outcomes, especially for bilateral and severe lumbar spinal stenosis, which is superior to unilateral transforaminal endoscopies.

Key words:spinal stenosis; minimally invasive surgery; unilateral biportal endoscopy; endoscopic foraminoplasty and decompression