单通道内镜下单侧入路双侧减压治疗退行性腰椎管狭窄症的疗效

谭芳; 李凯; 王健; 张锋; 宋鑫; 胥成平; 周捷

doi:10.7619/jcmp.20211422

单通道内镜下单侧入路双侧减压治疗退行性腰椎管狭窄症的疗效

Efficacy of unilateral laminotomy for bilateral decompression in treatment of degenerative lumbar spinal stenosis under single channel endoscopy

摘要

摘要:
目的探讨单通道内镜下行单侧入路双侧减压（ULBD）治疗退行性腰椎管狭窄症（DLSS）的疗效。
方法回顾性分析收治的29例DLSS患者资料。采用疼痛视觉模拟评分法（VAS）、Oswestry功能障碍指数（ODI）和改良Macnab标准评估疗效。
结果 29例患者均在全身麻醉下行单通道内镜下ULBD，手术顺利完成。平均手术时间为（98.33±15.50）min，术中出血量为（51.38±26.65）mL，术中透视次数为（3.03±0.94）次，术后住院时间为（3.07±1.10）d。所有患者随访均超过12个月，平均随访时间为（13.66±2.21）个月。术后腰部及腿部VAS评分、ODI均小于术前，差异有统计学意义（P < 0.05）；术后12个月，腰部及腿部VAS评分、ODI均小于术后1周，差异有统计学意义（P < 0.05）。1例患者术后出现下肢疼痛不适，2例患者术中出现硬膜撕裂。
结论单通道内镜下ULBD治疗无腰椎不稳的单节段DLSS，具有安全、有效、创伤小、恢复快等优点。

Abstract:
Objective To investigate the efficacy of unilateral laminotomy for bilateral decompression(ULBD) in treatment of degenerative lumbar spinal stenosis(DLSS) under single channel endoscopy.
Methods Data of 29 patients with DLSS was retrospectively analyzed. Outcomes were assessed by Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and modified Macnab criteria.
Results All 29 patients underwent ULBD with single channel endoscopy under general anesthesia, and the operations were successfully completed. The mean operation time was (98.33±15.50) minutes, the intraoperative blood loss was (51.38±26.65) mL, the number of intraoperative fluoroscopy was (3.03±0.94) times, and postoperative hospital stay was (3.07±1.10) days. All patients were followed up for more than 12 months, with a mean follow-up time of (13.66±2.21) months. VAS score and ODI of waist and leg after operation were significantly lower than those before operation (P < 0.05). VAS score and ODI of waist and leg at 12 months after surgery were significantly lower than those at one week after surgery (P < 0.05). One patient had postoperative pain and discomfort in the lower extremities, and two patients had intraoperative dural tears.
Conclusion ULBD under single channel endoscopy has the advantages of safety, effectiveness, less trauma and quick recovery in treatment of single-level DLSS without lumbar instability.

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