单侧双通道内镜下双侧减压治疗腰椎管狭窄症的临床疗效

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摘要目的〓分析单侧双通道内镜(unilateral biportal endoscopy，UBE)下行单侧椎板切除双侧椎管减压(unilateral laminotomy for bilateral decompression，ULBD)治疗腰椎管狭窄症的短期临床疗效。方法〓回顾性分析2022年6月至2023年4月张家港市第一人民医院应用UBE-ULBD治疗68例腰椎管狭窄症患者。其中中央椎管狭窄组(C组)30例，男17例，女13例；年龄55~82岁，平均(71.83±5.61)岁；术前腰椎管狭窄程度Schizas分级：B级14例，C级11例，D级5例。双侧侧隐窝狭窄组(L组)38例，男21例，女17例；年龄52~87岁，平均(70.92±9.27)岁；术前Schizas分级：A级5例，B级21例，C级12例。采用疼痛视觉模拟评分(visual analogue scales，VAS)及Oswestry功能障碍指数(Oswestry disability index，ODI)评估疗效，依据Macnab标准评估优良率。术后硬脊膜囊改善率=(术后硬脊膜囊横截面积－术前硬脊膜囊横截面积)/术前硬脊膜囊横截面积×100%。结果〓C组患者随访10~18个月，平均(13.27±1.60)个月；L组患者随访10~18个月，平均(12.75±2.70)个月。手术时间C组为(105.72±10.54)min，L组为(108.16±13.04)min；术后患者血红蛋白下降C组为(9.32±6.71)g/L，L组为(10.17±7.18)g/L；术后引流量C组为(32.27±5.81)mL，L组为(35.62±3.19)mL；术后下地时间C组为(1.24±0.27)d，L组为(1.36±0.54)d；术后住院时间C组为(4.18±1.17)d，L组为(4.38±1.40)d。所有患者术后各时间点腰、腿痛VAS和ODI均明显改善(P＜0.05)；临床疗效优良率C组为93.33%(28/30)，L组为92.10%(35/38)；硬脊膜囊改善率C组为(101.36±30.10)%，L组为(86.24±45.81)%。术后C组患者的病变节段均恢复至Schizas A级；L组有2例由术前Schizas C级恢复至术后Schizas B级，其余均恢复至Schizas A级。两组各1例术中发生硬脊膜囊撕裂。L组有1例术后出现椎管内血肿，行二次手术清除。结论〓UBE下行ULBD治疗腰椎管狭窄症可充分减压，创伤小、恢复快、临床疗效满意，是一种安全、高效的微创手术方式。

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	赵理平
	王黎明
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	宋锦程
	陈国兆
	沙卫平

基金资助:张家港市科技局项目(ZKYL2241)

作者简介: 赵理平(1982－ )，男，副主任医师，张家港市第一人民医院，苏州大学附属张家港医院骨科，lpzhao2008@163.com

引用本文:

赵理平，王黎明，曹泽，宋锦程，陈国兆，沙卫平. 单侧双通道内镜下双侧减压治疗腰椎管狭窄症的临床疗效[J]. 实用骨科杂志, 2024, 30(8): 732-.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2024/V30/I8/732

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