单孔双入路脊柱内镜技术治疗腰椎管狭窄症临床疗效研究

Clinical efficacy research of once-hole dual approach spine endoscope for lumbar spinal stenosis

摘要:

摘 要 目的：分析比较单孔双入路脊柱内镜（once-hole dual approach spine endoscope，OSE）技术和单侧双通道内镜（unilateral biportal endoscopy，UBE）技术治疗腰椎管狭窄症(lumbar spinal stenosis, LSS)的临床疗效。方法：回顾性分析多临床研究中心（中国人民解放军总医院第六医学中心、昆明医科大学第一附属医院运动医学科和曲靖市第二人民医院脊柱外科）从2022年1月-2022年12月采用OSE技术和UBE 技术完成的148例腰椎管狭窄症患者的临床资料，其中OSE组73例，男45例，女34例，年龄62.75±6.06岁；UBE组75例，男49例，女31例，年龄61.28±6.37岁。记录两组病人的手术时间、术中透视次数、术中出血量、切口长度、住院时间、手术并发症等情况。所有病人完成12个月随访，分析比较两组病人术前及术后各时间节点（术前、术后1月、术后3月、术后6月、术后12月）腰、腿部视觉模拟评分法（visual analogue scale, VAS）评分、Oswestry功能障碍指数（oswestry disability index, ODI），术前及术后随访辅助检查资料（椎间隙高度、硬膜囊横截面积、小关节保留率）变化情况；采用改良MacNab标准评价两组病人末次随访手术疗效。结果：148例患者均顺利完成手术及随访，OSE组与UBE组手术时间、术中透视次数、术中出血量、住院时间、手术并发症比较差异均无统计学意义（P>0.05）。与UBE组相比，OSE组手术切口长度更小，差异有统计学意义（P<0.05）。两组患者术后1月、3月、6月、12月腰腿痛评分及ODI值均较术前明显改善，差异有统计学意义（P<0.05），UBE组相比，OSE组术后1月、3月腰痛评分及ODI值改善更明显，差异有统计学意义（P<0.05），然而，术后6月、12月腰痛评分及ODI值两组间比较差异无统计学意义（P>0.05）。术前及术后各时间点腿痛评分两组间比较差异均无统计学意义（P>0.05）。两组术后手术节段硬膜囊横截面积较术前明显增大，差异有统计学意义（P<0.05），两组间比较差异无统计学意义（P>0.05）。与入路侧相比，对侧小关节保留率更高，差异有统计学意义（P<0.05），两组间比较差异无统计学意义（P>0.05）。两组术后各时间点椎间隙高度与术前无明显变化，差异均无统计学意义（P>0.05）。术后12月手术优良率两组间比较差异无统计学意义（P>0.05）。手术并发症：两组术中各出现硬脊膜损伤1例，差异无统计学意义（P>0.05）。结论：OSE技术治疗腰椎管狭窄症同时兼容开放手术和微创手术的优点，安全、有效，临床疗效确切。

Abstract:

Abstract Objective:To analyze and compare the clinical effect of once-hole dual approach spine endoscope (OSE) technology and unilateral biportal endoscopy(UBE) technology in the treatment of lumbar spinal stenosis. Methods: The clinical data of 148 patients with lumbar spinal stenosis who underwent OSE technology and UBE technology from January 2022 to December 2022 in multiple clinical research centers(Sixth Medical Center of PLA General Hospital/Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University/Department of Spinal Surgery, Qujing Second People's Hospita) were retrospectively analyzed. There were 73 patients in OSE group, 45 males and 34 females, aged 62.75±6.06 years. There were 75 cases in UBE group, including 49 males and 31 females, aged 61.28±6.37 years old. The operation time, intraoperative radiation times,the amount of blood loss, incision length, the duration of hospital stay, and surgical complications of the two groups were recorded. All patients were followed up for 12 months.The visual analogue scale (VAS) of lumbar and leg pain was compared between the two groups before operation and at each time point (1month, 3 months, 6 months, 12 months) after operation. VAS score, oswestry disability index (ODI), preoperative and postoperative follow-up data (disc height, the cross-sectional area of dural sac, facet joint retention rate); The modified MacNab standard was used to evaluate the curative effect of the last follow-up operation in the two groups. Results: 148 patients successfully completed the operation and follow-up, OSE group and UBE group had no significant differences in operation time, intraoperative radiation times, intraoperative amount of blood loss, the duration of hospital stay, surgical complications (P>0.05). Compared with UBE group, the incision length of OSE group was smaller, and the difference was statistically significant (P<0.05). The lumbar pain scores and ODI values at 1 month, 3 months, 6 months and 12 months after surgery were significantly improved in both groups compared with those before surgery (P<0.05). Compared with UBE group,lumbar pain scores and ODI values in OSE group at 1 month and 3 months after surgery were significantly improved, and the difference was statistically significant (P<0.05). There was no significant difference in lumbar pain scores and ODI values between the two groups at 6 and 12 months after surgery (P>0.05). There were no significant differences in leg pain scores between the two groups at each time point before and after surgery (P>0.05). The cross-sectional area of dural sac at the operative level was significantly increased between the two groups, with statistical significance (P<0.05),while there was no statistical significance between the two groups (P>0.05). Compared with the approach side, the contralateral facet joint retention rate was higher, the difference was statistically significant (P<0.05), but there was no statistically significant difference between the two groups (P>0.05). There was no significant difference in the disc height between the two groups at all time points after surgery (P>0.05). There was no significant difference in the excellent and good rate between the two groups 12 months after operation (P>0.05). Surgical complications: One case suffered dural sac tear in each of the two groups, and the difference was not statistically significant (P>0.05).Conclusion: OSE technique is compatible with the advantages of open surgery and minimally invasive surgery, which is a safe and effective method for lumbar spinal stenosis.