单通道与双通道内镜下侧隐窝减压术治疗腰椎侧隐窝狭窄症的近期疗效比较

Comparison of short-term efficacy of uni-channel and dual-channel endoscopic lateral recess decompression on short-term efficacy for lumbar lateral recess stenosis

  • 摘要:
    目的 比较单通道与双通道内镜下行侧隐窝减压术治疗腰椎侧隐窝狭窄症的近期临床疗效。
    方法 回顾性分析51例内镜下治疗腰椎侧隐窝狭窄症患者的临床资料, 根据不同手术方式分为经皮内镜下椎管减压术(PELD)组29例和单侧双通道内镜技术(UBE)组22例。比较2组手术时间、透视次数、术后卧床时间、术后各时点腰、腿部视觉模拟评分法(VAS)评分、Oswestry功能障碍指数(ODI); 采用改良MacNab标准评价2组疗效。
    结果 PELD组切口长度短于UBE组, PELD组术中透视次数多于UBE组,差异有统计学意义(P < 0.05); 2组手术时间、术后卧床时间比较,差异均无统计学意义(P>0.05)。术后3 d, PELD组腰痛VAS评分低于UBE组,差异有统计学意义(P < 0.05)。术前、术后3个月及末次随访时, 2组腰痛VAS评分比较,差异无统计学意义(P>0.05); 术前和术后3 d、3个月及末次随访时, 2组腿痛VAS评分及ODI比较,差异无统计学意义(P>0.05)。末次随访时, PELD组改良MacNab标准优良率为89.7%(26/29), UBE组为90.9%(20/22), 差异无统计学意义(P>0.05)。
    结论 应用PELD和UBE技术行侧隐窝减压术治疗腰椎侧隐窝狭窄症近期疗效均较佳。PELD较UBE更微创,仅需局部麻醉即可完成,对于神经根腹侧的减压更优,而UBE灵活性更好,对于神经根背侧减压更彻底。

     

    Abstract:
    Objective To compare the short-term clinical efficacy of uni-channel and dual-channel endoscopic lateral recess decompression on short-term efficacy for lumbar lateral recess stenosis.
    Methods The clinical data fifty-one patients with lumbar lateral recess stenosis were retrospectively analyzed. According to different surgical methods, they were divided into percutaneous endoscopic lumbar discectomy (PELD) group (n=29) and unilateral biportal endoscopic (UBE) group (n=22). The operation time, fluoroscopy times, postoperative bedridden time, Visual Analogue Scale (VAS) of lumbar and legs of different time points and Oswestry disability index (ODI) were compared between the two groups; modified MacNab standard was used to evaluate the efficacy of the two groups.
    Results The incision length in the PELD group was significantly shorter, and the number of intraoperative fluoroscopy in the PELD group was significantly more than that in the UBE group (P < 0.05); there were no significant differences in operation time and postoperative bed rest time between the two groups (P>0.05). On the third postoperative day, the VAS score of low back pain in the PELD group was significantly lower than that in the UBE group (P < 0.05). There was no significant difference in VAS score of low back pain between the two groups before operation, 3 months after operation and at the last follow-up (P>0.05); there were no significant differences in VAS score and ODI of leg pain between the two groups before operation, 3 days, 3 months after operation and at the last follow-up (P>0.05). At last follow-up, the excellent and good rate of modified MacNab standard was 89.7% (26/29) in the PELD group and 90.9% (20/22) in the UBE group, and the difference was not statistically significant (P>0.05).
    Conclusion Both PELD and UBE techniques have good short-term efficacy in the treatment of lumbar lateral crypt stenosis. PELD is more minimally invasive than UBE, only requiring local anesthesia and better decompression of ventral nerve roots, while UBE is more flexible and more thorough for decompression of dorsal nerve roots.

     

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