单侧双通道内镜下腰椎椎间融合术治疗腰椎管狭窄症的疗效和影像学分析

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摘要目的探讨单侧双通道内镜下腰椎椎间融合术(unilateral biportal endoscopic lumbar interbody fusion，UBE-LIF)治疗腰椎管狭窄症(lumbar spinal stenosis，LSS)的疗效和影像学结果。方法回顾性分析2021年3月至2022年3月在新疆医科大学第一附属医院骨科接受UBE-LIF治疗的63例LSS患者的资料，男24例，女39例；年龄45～75岁，平均年龄(61.17±7.88)岁。记录患者的手术时间、术中出血量、术后引流量、术后下地时间、术后住院时间和并发症情况。采用腰背部和腿部视觉模拟评分(visual analog scale，VAS)、日本骨科协会(Japanese orthopaedic association，JOA)评分、Oswestry功能障碍指数(Oswestry disability index，ODI)及改良Macnab标准评估临床疗效。术后6个月和末次随访复查X线片或CT评估影像学结果，并采用Bridwell分级标准评估手术节段融合情况。结果 63例患者手术均顺利完成。手术时间100～195 min，平均(139.37±20.88) min；术中出血量85～190 mL，平均(124.52±21.58) mL；术后引流量15～65 mL，平均(35.48±10.34) mL；术后下地时间1～3 d，平均(1.70±0.59) d；术后住院时间3～6 d，平均(4.53±0.59) d。术后随访12～20个月，平均(15.20±2.23)个月。共发生8例并发症，发生率为12.69%。术后各随访时间点腰背部和腿部VAS、JOA评分及ODI均较术前明显改善，差异有统计学意义(P＜0.05)。末次随访时改良Macnab标准评价，优48例(76.19%)，良8例(12.70%)，可7例(11.11%)，优良率88.89%。术后6个月随访时，Bridwell分级Ⅰ级15例(23.81%)，Ⅱ级20例(31.75%)，Ⅲ级24例(38.10%)，Ⅳ级4例(6.35%)；末次随访时，Bridwell分级I级58例(92.06%)，Ⅱ级5例(7.94%)。结论 UBE-LIF治疗LSS具有良好的疗效和影像学结果，是一种安全、有效的微创融合手术方式，可为LSS患者提供新的治疗选择。

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	王湘斌
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	艾克拜尔·尤努斯
	李勇
	隆宇斌

关键词 ：腰椎退行性疾病, 腰椎管狭窄症, 单侧双通道内镜技术, 椎间融合术, 脊柱内镜手术

Abstract：

Objective To investigate the efficacy and radiological outcomes of unilateral biportal endoscopic lumbar interbody fusion (UBE-LIF) for lumbar spinal stenosis (LSS).Methods The data of 63 patients with LSS retrospectively analyzed，who underwent UBE-LIF in the Department of Orthopaedics in The First Affiliated Hospital of Xinjiang Medical University from March 2021 to March 2022.24 males and 39 females were included.The age ranged from 45 to 75 years，with an average of (61.17±7.88) years.The operation time，intraoperative blood loss，postoperative drainage volume，ambulation time，postoperative hospital stay and complications were recorded.The clinical efficacy was evaluated by visual analog scale (VAS) scores of low back and leg，Japanese orthopaedic association (JOA) score，Oswestry disability index (ODI)，and modified Macnab criteria.The radiological outcomes were evaluated by X-ray or CT 6 months after the operation and the final follow-up，and the fusion of the operated segments was assessed using Bridwell grading criteria.Results The procedures of 63 patients were completed successfully.The operation time was 100 to 195 minutes，with an average of (139.37±20.88) minutes.The intraoperative blood loss was 85 to 190 mL，with an average of (124.52±21.58) mL.Postoperative drainage volume was 15 to 65 mL，with an average of (35.48±10.34) mL.The ambulation time was 1 to 3 days，with an average of (1.70±0.59) days.Postoperative hospital stay was 3 to 6 days，with an average of (4.53±0.59) days.Postoperative follow-up 12 to 20 months，with an average of (15.20±2.23) months.A total of 8 complications occurred，with an incidence of 12.69%.The VAS scores of low back and leg，JOA score，and ODI were significantly improved compared to those before the operation at each postoperative follow-up time point，and the differences were statistically significant (P＜0.05).The modified Macnab criteria evaluation at the final follow-up showed that the outcomes were excellent in 48 cases (76.19%)，good in 8 cases (12.70%)，fair in 7 cases (11.11%)，with a rate of excellent and good was 88.89%.At the 6 month postoperative followup，15 cases (23.80%) were classified as Bridwell grade Ⅰ，20 cases (31.75%) as grade Ⅱ，24 cases (38.10%) as grade Ⅲ，4 cases (6.35%) as grade Ⅳ，respectively.At the final followup，58 cases (92.06%) were classified as Bridwell grade Ⅰ，5 cases (7.94%) as grade Ⅱ，respectively. Conclusion UBE-LIF is a safe and effective minimally invasive fusion procedure for the treatment of LSS with excellent efficacy and radiological outcomes，which can provide new treatment options for patients with LSS.

Key words： lumbar degenerative diseases lumbar spinal stenosis unilateral biportal endoscopy technique interbody fusion spinal endoscopic surgery

通讯作者: 王翀

作者简介: 王湘斌(1995－ )，男，研究生在读，新疆医科大学第一附属医院骨科，binaqin@foxmail.com

引用本文:

王湘斌，王翀，田征，艾克拜尔·尤努斯，李勇，隆宇斌. 单侧双通道内镜下腰椎椎间融合术治疗腰椎管狭窄症的疗效和影像学分析[J]. 实用骨科杂志, 2023, 29(9): 769-.
Wang Xiangbin，Wang Chong，Tian Zheng，Aikebaier Younusi，Li Yong，Long Yubin. Analysis of the Efficacy and Radiological Results of Unilateral Biportal Endoscopic Lumbar Interbody Fusion for Lumbar Spinal Stenosis. sygkzz, 2023, 29(9): 769-.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2023/V29/I9/769

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