摘要
目的:评价局麻单通道全脊柱内镜下单侧入路椎板切开双侧减压技术(Uniportal full-endoscopic unilateral laminotomy for bilateral decompression，UFE-ULBD)治疗腰椎管狭窄症(Lumbar spinal stenosis，LSS)的标准化手术技术要点、临床疗效及影像学变化。方法:回顾性分析2021年8月至2023年2月期间单中心临床确诊为LSS，且接受局部麻醉UFE-ULBD手术的患者。收集患者一般人口学资料、腰腿痛视觉模拟评分(visual analog scale，VAS)、Oswestry功能障碍指数(Oswestry Disability Index，ODI)以及改良Macnab分级。测量术前术后关节突关节切除角度、盘黄间隙减压率、骨性侧隐窝减压率以及硬膜囊横截面积等影像学参数。在术后1月、3月及末次随访时对上述指标进行随访。结果:共纳入53例患者(男31例，女22例)，其中单节段狭窄者49例，双节段狭窄者4例，共计57个手术节段。所有患者平均手术时间(77.5±18.7)min，平均术后住院时间(1.5±0.7)d，平均随访10.5个月。至末次随访时，腿痛VAS评分(1.2±2.1 vs. 6.0±0.8，P<0.001)、腰痛VAS评分(1.3±1.9 vs. 6.0±0.8，P<0.001)以及ODI评分(24.0±22.4% vs. 71.2±6.2%，P<0.001)均较术前改善显著。术后硬膜囊横截面积较术前显著扩大(148.4±40.6 mm2vs. 56.0±21.1 mm2，P<0.001)，平均扩大率为(190.4±101.4)%。所有患者在随访期间均未出现手术并发症。结论:局部麻醉下UFE-ULBD技术治疗LSS可获得满意的临床和影像学效果。
Abstract
Objective:To investigate the standard surgical technique, clinical and radiological outcomes of uniportal full-endoscopic unilateral laminotomy for bilateral decompression (UFE-ULBD) under local anesthesia for patients with lumbar spinal stenosis (LSS).Methods:Patients with LSS who underwent UFE-ULBD under local anesthesia from a single spine center were retrospectively analyzed between August 2021 and February 2023. Patient demographics, visual analog scale (VAS) scores for leg pain and back pain, Oswestry Disability Index (ODI) scores, modified Macnab grade, angle of facetectomy, decompression ratio of disc-flava ligament space, decompression ratio of osseous lateral recess, and dural sac cross-sectional area were systematically collected. The above measurements were evaluated at 1 month, 3 months after surgery, and at the last follow-up.Results:Fifty-three patients (31 males and 22 females) were retrospectively enrolled in this study, including 49 patients with single-level stenosis and 4 patients with double-level stenosis, with a total of 57 surgical levels. The mean operation time was (77.5±18.7) minutes, the mean postoperative hospital stay was (1.5±0.7) days, and the mean follow-up was 10.5 months. At the last follow-up, the VAS score for leg pain (1.2±2.1 vs. 6.0±0.8, P<0.001), the VAS score for back pain (1.3±1.9 vs. 6.0±0.8, P<0.001), and the ODI score (24.0±22.4% vs. 71.2±6.2%, P<0.001) improved significantly. The postoperative dural sac cross-sectional area obviously enlarged (148.4±40.6 mm2vs. 56.0±21.1 mm2, P<0.001) with compared to preoperative, with an enlargement ratio of 190.4±101.4%. No complication was detected during the follow-up.Conclusion:The UFE-ULBD under local anesthesia could provide satisfactory clinical and radiological outcomes for patients with LSS.
基金项目
首都卫生发展科研专项(2020-2-4091)
北京市通州区科技计划医疗卫生专项重点项目(Q22059-3)
北京市卫生健康科技成果和适宜技术推广项目(BHTPP2022074)
北京市医院管理中心青年人才培养"青苗"计划(QMS20220116)
万方数据