目的 探讨单侧双通道脊柱内镜(UBE)治疗退行性腰椎疾病(DLD)术后疗效与影响因素关系.方法 对2021年2月至2023年3月收治本科室的61例DLD患者进行回顾性分析,评价其术后疗效.随访时间12～38个月.男35个,女26个,年龄19～81岁,平均年龄54.4岁.手术节段均为单节段,共61节段.记录患者围手术期及手术并发症情况;随访以末次随访为终止时间.采用疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)和改良MacNab标准评价临床疗效;手术前后行腰椎CT三维重建检查,观察并测量关节突关节切除内侧角(β角);椎间盘类型按照分类定位系统MSU(Michgan State University)基于MRI横断位分A、B、C区,依据区域定位法FSU(Functional Spine Unit)基于MRI或CT横断位、矢状位分级1～4级;统计采用配对t检验,及方差分析.结果 61例患者均顺利完成手术.其中行腰椎间盘突出手术61例,其中合并中央管狭窄29例,合并侧隐窝狭窄54例.术中出现硬膜囊撕裂2例.术后出现短暂性下肢麻木3例,类脊髓综合征1例,感染1例.患者术后随访(12～38)个月.术后随访时,患者腿部VAS、ODI较术前明显下降(P值均＜0.05).术后末次随访时依据改良MacNab标准,优良率为65.6％(40/61).腰椎三维CT影像学方面,测量β角均小于90°,平均值83.59°,范围(66.72°～89.32°).基于MSU分区,A区37例,B区15例,C区 9例;基于FSU位置分级,分别为1级1例,2级25例,3级2例,合并1和2级26例,2和3级4例,1和2、3级3例.方差分析显示术后满意度与椎间盘分区及分级、β角无关,与术后疼痛及功能障碍指数相关.结论 单侧双通道脊柱内镜治疗退行性腰椎疾病术后疗效可能与术后β角及椎间盘分区、分级无关.分级、分区越复杂,手术难度越大,早期开展这项技术遇到的困难可能越多.
The relationship between postoperative efficacy and influencing factors of unilateral biportal spinal endoscopy in the treatment of degenera-tive lumbar spine diseases
Objective Exploring the relationship between the postoperative efficacy and influencing factors of unilateral biportal spinal en-doscopy(UBE)in the treatment of degenerative lumbar disease(DLD).Methods A retrospective analysis was conducted on 61 patients with degen-erative lumbar spine disease admitted to our department from February 2021 to March 2023 to evaluate their postoperative efficacy.There were 35 males and 26 females,with an average age of 54.4 years,ranging from 19 to 81 years.The surgical segments were all single segments,with a total of 61 cases and followed up for 12-38 months.The patient's perioperative situation and surgical complications were recorded.Clinical efficacy was eval-uated by Pain Visual Analog Scale(VAS),Oswestry Dysfunction Index(ODI),and Modified MacNab criteria.All patients were performed lumbar three-dimensional reconstruction CT examination before and after surgery to observe and measure the medial angle of the facet joint resection(β Angle).Ac-cording to the system MSU based on MRI transverse section,the position of lumbar disc herniation was classified into areas A,B,and C.According to the regional positioning method FSU(functional spine unit),the patients were graded into 1-4 levels based on MRI or CT transverse and sagittal sec-tions.Paired t-tests and variance analysis were used for statistics.Results All 61 patients were successfully completed the lumbar disc herniation surgery.29 cases were combined with central canal stenosis,and 54 cases were combined with lateral recess stenosis.Aural sac tear was occurred in 2 cases during surgery.After surgery,there were 3 cases of transient lower limb numbness,1 case of myeloid syndrome,and 1 case of infection.The pa-tient was followed up for 12-38 months after surgery.The VAS and ODI of the patient's legs significantly decreased compared to before surgery(P＜0.05).At the last follow-up after surgery,according to the modified MacNab criteria,the excellent and good rate was 65.6％(40/61).The β Angles of all patients measured by lumbar three-dimensional CT were less than 90°,with an average value of 83.59(66.72-89.32).Based on MSU partitioning,there were 37 cases in zone A,15 cases in zone B,and 9 cases in zone C.Based on FSU location classification,there were 1 case at level 1,25 cases at level 2,2 cases at level 3,26 cases at levels 1 and 2,4 cases at levels 2 and 3,and 3 cases at levels 1 and 2 and 3.The variance analysis showed that postoperative satisfaction was not related to intervertebral disc partitioning or grading and β Angle,but related to postoperative pain and function-al impairment index.Conclusion The β angle and intervertebral disc partitioning and grading may not related to the postoperative efficacy and outcomes of unilateral biportal spinal endoscopy in the treatment of degenerative lumbar spine diseases.The more complex the grading and partition-ing,the greater the difficulty of surgery,and the more difficulties may be encountered in early implementation of this technology.
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