单侧双通道内镜治疗多节段退变性腰椎疾病（开放获取）

Unilateral biportal endoscopy for the treatment of multilevel degenerative lumbar disease

摘要:

[目的] 探讨单侧双通道脊柱内镜技术（unilateral biportal endoscopy, UBE） 治疗多节段退变性腰椎疾病（multileveldegenerative lumbar disease, MDLD） 的安全性和临床疗效。[方法] 回顾性分析2020 年7 月—2022 年6 月本科收治的29 例MDLD 患者的临床资料，均采用UBE 技术治疗。评价临床及影像结果。[结果] 29 例患者均顺利完成手术，手术时间平均（178.6±26.5） min，术中透视次数平均（10.9±2.9） 次。并发症方面，硬膜囊撕裂2 例，短暂性下肢麻木2 例，硬膜外血肿1 例，均未引起严重不良后果。随访时间平均（19.3±6.3） 个月，随术前、术后7 d、术后3 个月至术后12 个月的时间推移，VAS 评分[(6.6±1.5), (3.2±0.5), (2.1±0.6), (1.7±0.5), P＜0.001]、ODI 评分[(58.6±11.2), (33.5±4.6), (22.8±3.8), (17.5±2.2), P＜0.001]、JOA 评分[(15.6±2.4), (19.6±2.0), (21.2±2.2), (24.7±2.5), P＜0.001] 均显著改善。术后12 个月，按改良MacNab 疗效评定标准，优良率86.2%。影像方面，与术前相比，术后12 个月椎管面积显著增加[(58.3±9.6) mm2, (118.4±14.2) mm2, P＜0.001]。术后各节段关节突关节面积保留率均超过60%。[结论] UBE 技术治疗MDLD 的临床效果满意，保留更多小关节突，有利于维持腰椎的稳定性，是一种安全有效的术式。

Abstract:

[Objective] To explore the safety and clinical efficacy of unilateral biportal endoscopy (UBE) in the treatment of multileveldegenerative lumbar disease ( MDLD). [Methods] Twenty nine patients who received surgical decompression with UBE for MDLD from July2020 to June 2022 were retrospectively analyzed. The clinical and imaging data were evaluated. [Results] All the 29 patients successfullycompleted the operation, with the average operation time of (178.6±26.5) min, the average intraoperative fluoroscopy times of (10.9±2.9). Interm of complication, dural tear happened in 2 cases, transient lower limb numbness in 2 cases, and epidural hematoma in 1 case, which notled serious consequence in anyone of them. The follow-up period lasted for (19.3±6.3) months in average. As time went from the point beforesurgery, to 7 days, 3 months and 12 months postoperatively, the VAS score for pain [(6.6±1.5), (3.2±0.5), (2.1±0.6), (1.7±0.5), P＜0.001], ODIscore [(58.6±11.2), (33.5±4.6), (22.8±3.8), (17.5±2.2), P＜0.001], JOA score [(15.6±2.4), (19.6±2.0), (21.2±2.2), (24.7±2.5), P＜0.001] signifi-cantly improved. At 12 months after operation, the excellent and good rate was of 86.2%, according to the modified MacNab criteria. In termsof imaging, there was a significant increase in spinal canal area at 12 months after surgery compared with that preoperatively [(58.3±9.6)mm2, (118.4±14.2) mm2, P＜0.001]. The retention rate of facet joints was more than 60% in all levels. [Conclusion] The UBE used in thetreatment of MDLD does achieve satisfactory clinical outcomes, with a benefit to maintain the stability of lumbar spine by preserving morefacet joints, is a safe and effective operation.