单侧双通道内镜下经椎间孔腰椎间融合术治疗腰椎管狭窄症的效果及其对腰椎功能恢复的影响

Curative effect of unilateral biportal endoscopy transforaminal lumbar interbody fusion and its influences on the recovery of lumbar function in lumbar spinal stenosis

摘要:

目的 分析单侧双通道内镜（UBE）下经椎间孔腰椎间融合术（TLIF）治疗腰椎管狭窄症（LSS）的效果及其对腰椎功能恢复的影响。方法 回顾性分析2021年9月－2023年9月该院收治的70例继发性LSS患者的临床资料，根据手术方法不同，将患者分为UBE-TLIF组（39例）和TLIF组（31例）。比较两组患者术后并发症发生情况，以及手术指标（手术时间、术后下床时间和住院时间）、术前、术后3 d和术后7 d血红蛋白、术后3 d硬脊膜囊截面积（DSCA）改善率、不同时间点腰腿疼痛视觉模拟评分法（VAS）和Oswestry功能障碍指数（ODI）。结果 UBE-TLIF组手术时间、术后下床时间和住院时间明显短于TLIF组，差异均有统计学意义（P < 0.05）；术后3 d，UBE-TLIF组DSCA改善率明显高于TLIF组，差异有统计学意义（P < 0.05）；术后3和7 d，两组患者血红蛋白明显下降，但UBE-TLIF组高于TLIF组，差异均有统计学意义（P < 0.05）；术后3 d、术后1个月和术后3个月，两组患者VAS和ODI明显低于术前，且UBE-TLIF组低于TLIF组，差异均有统计学意义（P < 0.05）；UBE-TLIF组术后并发症发生率为7.69%，明显低于TLIF组的25.81%，差异有统计学意义（P < 0.05）。结论 UBE-TLIF治疗继发性LSS的临床疗效较TLIF好，能明显减轻患者疼痛，实现腰椎充分减压，促进腰椎功能恢复。值得临床推广应用。

Abstract:

Objective To analyze the curative effect of unilateral biportal endoscopy (UBE) transforaminal lumbar interbody fusion (TLIF) and its influences on the recovery of lumbar function in lumbar spinal stenosis (LSS).Methods 70 patients with secondary LSS were retrospectively analyzed between September 2021 and September 2023. According to different surgical methods, they were divided into UBE-TLIF group (39 cases) and TLIF group (31 cases). The occurrence of postoperative complications during follow-up, surgical indexes (operation time, postoperative leaving bed time, and hospitalization time), hemoglobin level before surgery and 3 and 7 d after surgery, improvement rate of dural sac cross-sectional area (DSCA) at 3 d after surgery, the visual analogue scale (VAS) and Oswestry disability index (ODI) at different time points were compared between the two groups.Results The operation time, postoperative leaving bed time and hospitalization time in UBE-TLIF group were shorter than those in TLIF group, the differences were statistically significant (P < 0.05). At 3 d after surgery, improvement rate of DSCA in UBE-TLIF group was higher than that in TLIF group, the difference was statistically significant (P < 0.05). At the 3 d and 7 d after surgery, hemoglobin level was decreased in both groups, which was higher in UBE-TLIF group than TLIF group, the difference was statistically significant (P < 0.05). At 3 d, 1 month and 3 months after surgery, VAS and ODI in both groups were decreased than those before the surgery, which were lower in UBE-TLIF group than TLIF group, the differences were statistically significant (P < 0.05). The incidence of postoperative complications in UBE-TLIF group was lower than that in TLIF group (7.69% vs 25.81%), the difference was statistically significant (P < 0.05).Conclusion The curative effect of UBE-TLIF is better in patients with secondary LSS, which can significantly relieve pain, achieve full lumbar decompression and promote the recovery of lumbar function. It is worthy clinical application.