单侧双通道内镜与显微内镜单侧椎板切开双侧减压术在腰椎椎管狭窄症中的应用效果及安全性分析

Application effect and safety analysis of unilateral laminectomy and bilateral decompression under unilateral biportal endoscopy and microendoscope in lumbar spinal stenosis

摘要:

目的 分析单侧双通道内镜（UBE）与显微内镜（MED）单侧椎板切开双侧减压术用于腰椎椎管狭窄症中的效果及安全性。方法 选取2021年1月－2022年12月该院诊治的腰椎椎管狭窄症患者80例，采用随机数表法分为对照组和研究组，各40例。对照组给予MED单侧椎板切开双侧减压术治疗，研究组给予UBE单侧椎板切开双侧减压术治疗。比较两组患者手术时间和术中出血量；比较术前、术后1和3个月，以及末次随访时的Oswestry功能障碍指数（ODI）和腰痛、腿痛视觉模拟评分法（VAS）；比较治疗效果和并发症发生情况。结果 两组患者手术时间和术中出血量比较，差异均无统计学意义（P > 0.05）。术后1和3个月，以及末次随访时，两组患者ODI较术前降低，差异均有统计学意义（P < 0.05），但两组组间比较，差异无统计学意义（P > 0.05）。术后1和3个月，以及末次随访时，两组患者腰痛和腿痛VAS较术前降低，差异均有统计学意义（P < 0.05），且研究组明显低于对照组（P < 0.05）。研究组临床治疗优良率为97.50%，与对照组的92.50%比较，差异无统计学意义（P > 0.05）。研究组并发症发生率为2.50%，明显低于对照组的15.00%，差异有统计学意义（P < 0.05）。结论 UBE和MED单侧椎板切开双侧减压术，在腰椎椎管狭窄症中的治疗效果相当，均可有效促进功能恢复，但UBE可更有效地减轻疼痛，且术后并发症较少。

Abstract:

Objective To analyze the efficacy and safety of unilateral laminectomy and bilateral decompression under unilateral biportal endoscopy (UBE) and microendoscope (MED) in lumbar spinal stenosis.Methods 80 patients with lumbar spinal stenosis from January 2021 to December 2022 were selected and divided into two groups by numerical table method, the control group and the study group, and the number of cases was 40. The grouping method was random number table method. The control group was treated with unilateral laminectomy and bilateral decompression under MED, while the study group was treated with unilateral laminectomy and bilateral decompression under UBE. Operation time, intraoperative blood loss, Oswestry disability index (ODI) and visual analogue scale (VAS) of lumbago and leg pain were obtained before surgery, 1, 3 months after surgery and at the last follow-up, efficacy and complications were compared between the two groups.Result There were no significant differences in operative time and blood loss between the study group and the control group (P > 0.05). 1, 3 months after surgery and at the last follow-up, ODI in both groups were lower than those before surgery (P < 0.05), but there was no difference between the study group and the control group (P > 0.05). The VAS of lumbago and leg pain in both groups were lower than those before surgery (P < 0.05), at 1, 3 months after surgery and the last follow-up, and the study group was significantly lower than the control group (P < 0.05). The excellent and good rate of clinical treatment in the study group was 97.50%, and there was no difference compared with 92.50% in the control group (P > 0.05). The complication rate of the study group was 2.50%, significantly lower than that of the control group (15.00%) (P < 0.05).Conclusion Unilateral laminectomy and bilateral decompression under the UBE and MED have similar efficacy in the treatment of lumbar spinal stenosis, both of which can effectively promote functional recovery, but UBE can reduce pain more effectively and has fewer postoperative complications.