腰椎管狭窄症单侧双路内镜与通道下减压比较（开放获取）

Comparison of unilateral biportal endoscopic decompression versus channel decompression for lumbar spinal stenosis

摘要:

[目的] 探讨腰椎管狭窄症单侧双通道脊柱内镜（unilateral biportal endoscopy, UBE） 与通道下减压对腰椎椎管狭窄症（lumbar spinal stenosis, LSS） 的治疗疗效。[方法] 将60 例符合要求的LSS 患者纳入本研究，根据医患沟通结果，将患者分为两组，27 例采用UBE 术治疗（UBE 组），33 例采用小通道直视下减压术治疗（通道组）。比较两组围术期、随访及影像资料。[结果] 两组患者均顺利完成手术。UBE 组患者的手术时间[(45.9±7.6) min vs (54.4±2.9) min, P＜0.001]、术后3 d 阿片类药物使用量[(215.6±49.3) mg vs (260.4±67.5) mg, P=0.006]、术后1 d CRP [(15.6±3.7) mg/L vs (17.9±2.1) mg/L, P=0.004]、术后下地时间[(1.2±0.4) d vs (1.6±0.2) d, P＜0.001]、术后住院时间[(5.1±1.3) d vs (6.0±0.8) d, P=0.002] 显著少于通道组。随时间推移，两组VAS、ODI 评分均显著减少（P＜0.05），术后2 个月UBE 组ODI 评分显著优于通道组（P＜0.05）。影像方面，术后两组椎管面积显著增加（P＜0.05），UBE 组椎旁肌截面积（cross sectional area, CSA） 无显著变化（P＞0.05），通道组CSA 显著减小（P＜0.05）。相应时间点，两组椎管面积的差异均无统计学意义（P＞0.05），术后相应时间点UBE 组CSA 显著大于通道组（P＜0.05）。[结论] UBE、小通道直视下减压术均是治疗LSS 的有效方法，但UBE 可降低患者术后麻醉药物用量、术中组织损伤及术后炎症反应。

Abstract:

[Objective] To investigate the clinical outcomes of unilateral biportal endoscopic decompression (UBED) versus channel de-compression (CD) in the treatment of lumbar spinal stenosis (LSS). [Methods] A total of 60 patients with LSS who met the criteria were in-cluded in this study. According to doctor-patient communication, 27 patients were treated with UBED, while other 33 patients were treatedwith CD. The perioperative, follow-up and imaging data of the two groups were compared. [Results] The corresponding operation was suc-cessfully completed in both groups. The UBDE group proved significantly superior to the CD group in terms of operative time [(45.9±7.6)min vs (54.4±2.9) min, P＜0.001], opioid consumption 3 day postoperatively [(215.6±49.3) mg vs (260.4±67.5) mg, P=0.006], CRP 1 daypostoperatively [(15.6±3.7) mg/L vs (17.9±2.1) mg/L, P=0.004], postoperative ambulation time [(1.2±0.4) days vs (1.6±0.2) days, P＜0.001],postoperative hospitalization [(5.1±1.3) days vs (6.0±0.8) days, P=0.002]. The VAS and ODI scores in both groups were significantly de-creased over time (P＜0.05), and ODI scores in the UBED group were significantly better than that in the CD group 2 months after surgery(P＜0.05). Regarding to imaging, the spinal canal area significantly increased in both groups after surgery (P＜0.05). The paravertebral mus-cle cross sectional area (CSA) in the UBED group remained unchanged (P＞0.05), while which in the CD group was significantly decreasedover time (P＜0.05). There was no significant difference in spinal canal area between the two groups at corresponding time points (P＞0.05),and CSA in the UBED group was significantly higher than that in the CD group at all corresponding time points after surgery (P＜0.05).[Conclusion] Both UBED and CD are effective methods for the treatment of LSS. By comparison, the UBED takes advantages of reducingthe amount of postoperative anesthetic drugs, intraoperative tissue injury and postoperative inflammation over the CD.