文献类型：期刊文献

中文题名：单侧双通道内镜与大通道内镜技术治疗腰椎椎管狭窄症的临床疗效比较

英文题名：Comparison of clinical efficacy of unilateral dual-channel endoscopy and large-channel endoscopy techniques in the treatment of lumbar spinal canal stenosis

作者：任毅[1];于天爽[1];邱晓明[2];陈伟国[2];张万乾[2];赵恒[2];杨建霞[1];谢芋涛[1];陶瑜晶[1];邵文鹤[1];杨鹏程[1];叶丙霖[2,3]

第一作者：任毅

机构：[1]甘肃中医药大学,甘肃兰州730000;[2]甘肃省中医院,甘肃兰州730000;[3]甘肃省中医药研究院,甘肃兰州730000

第一机构：甘肃中医药大学

年份：2026

卷号：39

期号：3

起止页码：246

中文期刊名：中国骨伤

外文期刊名：China Journal of Orthopaedics and Traumatology

基金：甘肃省卫生健康行业科研项目(编号:GSWSKY2022-20)。

语种：中文

中文关键词：单侧双通道内镜;大通道内镜;腰椎椎管狭窄症;微创手术;病例对照研究

外文关键词：Unilateral dual channel endoscopy;Large channel endoscopy;Lumbar spinal stenosis;Endoscopic minimally invasive surgery;Case-control study

摘要：目的:探讨单侧双通道内镜(unilateral biportal endoscopy,UBE)与大通道内镜技术治疗腰椎椎管狭窄症(lumbar spinal stenosis,LSS)的临床疗效和影像学结果。方法:自2021年5月至2023年11月,采用UBE或大通道内镜手术治疗70例中央型轻度LSS患者,男45例,女25例;年龄50~75(57.1±6.0)岁;病程3~12(5.6±2.1)个月;手术节段L_(3,4)11例,L_(4,5)38例,L_(5)S_(1)21例。根据治疗方式不同分为两组,每组35例。UBE组男24例,女11例;年龄50~75(57.2±6.2)岁;病程3~12(5.4±2.1)个月;L_(3,4)6例,L_(4,5)18例,L_(5)S_(1)11例。大通道内镜组男21例,女14例;年龄50~75(57.0±5.9)岁;病程3~10(5.9±2.1)个月;L_(3,4)5例,L_(4,5)20例,L_(5)S_(1)10例。记录并比较两组手术时间、住院时间以及术后并发症情况;分别于术前、术后3 d及术后3、6个月比较视觉模拟评分(visual analog scale,VAS)和腰椎Oswestry功能障碍指数(Oswestry disability index,ODI)、日本骨科协会腰椎功能(Japanese Orthopaed Association,JOA)评分;比较术前与术后3 d腰椎MRI中硬膜囊的面积变化情况。结果:70例患者均顺利完成手术并获得随访,时间3~6(5.5±0.8)个月。术后UBE组2例出现短期对侧下肢麻木感觉症状,服用甲钴胺、依托考昔片等药物后好转;大通道内镜组1例发生硬膜囊轻微撕裂,休息后好转。两组手术时间、住院时间比较,差异均无统计学意义(P>0.05)。术前、术后3 d及术后3、6个月,UBE组VAS分别为(4.51±0.51)、(3.69±0.47)、(2.34±0.48)(1.37±0.49)分,ODI分别为(41.00±2.26)%、(32.51±2.93)%、(20.09±2.89)%、(10.71±2.26)%,JOA评分分别为(11.02±2.80)、(18.34±2.80)、(22.85±2.21)、(25.74±1.73)分;大通道内镜组VAS分别为(4.29±0.67)、(2.97±0.66)、(1.57±0.56)、(1.23±0.43)分,ODI分别为(41.54±2.28)%、(32.80±2.62)%、(20.94±2.66)%、(11.23±2.24)%,JOA评分分别为(10.94±2.74)、(15.25±2.57)、(21.71±2.44)、(23.22±3.31)分;两组术后各时间点VAS、ODI、JOA评分比较,差异均有统计学意义(P<0.05)。UBE组术前及术后3 d硬膜囊面积分别为(66.7±7.7)、(102.8±6.6)mm^(2),大通道内镜组分别为(67.1±7.7)、(97.2±6.4)mm^(2),UBE组术后3 d硬膜囊面积优于大通道内镜组,差异有统计学意义(P<0.05)。结论:采用UBE技术和大通道内镜技术治疗LSS均能获得满意的临床疗效,但前者减压更彻底,硬膜囊扩张面积优于大通道内镜技术。
Objective To explore clinical efficacy and imaging results of unilateral biportal endoscopy(UBE)and large-channel endoscopy techniques in treating lumbar spinal stenosis(LSS).Methods From May 2021 to November 2023,70 patients with central mild LSS were treated with UBE or large-channel endoscopic surgery,including 45 males and 25 females,aged from 50 to 75 years old with an average of(57.1±6.0)years old;the courses of disease ranged from 3 to 12 months with an average of(5.6±2.1)months;11 patients on L_(3,4),38 patients on L_(4,5),and 21 patients with L_(5)S_(1).All patients were divided into two groups according to different treatment methods,with 35 patients in each group.There were 24 males and 11 females in unilateral dual-channel endoscopy group,aged from 50 to 75 years old with an average of(57.2±6.2)years old;the course of disease ranged from 3 to 12 months with an average of(5.4±2.1)months;the surgical segments included L_(3,4)(6 cases),L_(4,5)(18 cases),and L_(5)S_(1)(11 cases).There were 21 males and 14 females in large channel endoscopy group,aged from 50 to 75 years old with an average of(57.0±5.9)years old;the course of disease ranged from 3 to 10 months with an average of(5.9±2.1)months;the surgical segments included L_(3,4)(5 cases),L_(4,5)(20 cases),and L_(5)S_(1)(10 cases).Operation time,hospital stay and postoperative complications between two groups were record and compared;visual analog scale(VAS)and Oswestry disability index(ODI)of lumbar spine,Japanese Orthopaedic Association(JOA)were compared respectively before operation,3 days,3 and 6 months after operation;area changes of dural sac in lumbar MRI before operation and 3 days after operation were compared.Results All 70 patients were successfully completed surgery and were followed up for 3 to 6 months with an average of(5.5±0.8)months.In UBE group after operation,2 patients presented with short-term numbness in contralateral lower extremity after operation,and the symptoms improved after treatment with conventional drugs such as mecobalamin and etoricoxib tablets.In large channel endoscopy group,1 patient had a slight tear of dural sac and improved after rest.There were no statistically significant differences in operation time and hospital stay between two groups(P>0.05).Before operation,3 days,3 and 6 months after operation,VAS of UBE group were(4.51±0.51),(3.69±0.47),(2.34±0.48),and(1.37±0.49)points respectively;ODI were(41.00±2.26)%,(32.51±2.93)%,(20.09±2.89)%,(10.71±2.26)%,respectively;JOA score were(11.02±2.80),(18.34±2.80),(22.85±2.21),(25.74±1.73)points,respectively;VAS of large channel endoscopy group were(4.29±0.67),(2.97±0.66),(1.57±0.56),and(1.23±0.43)points,respectively;ODI were(41.54±2.28)%,(32.80±2.62)%,(20.94±2.66)%,and(11.23±2.24)%,respectively;JOA score were(10.94±2.74),(15.25±2.57),(21.71±2.44),and(23.22±3.31)points,respectively,the comparisons of VAS,ODI and JOA scores at each time point after operation between two groups were statistically significant differences(P<0.05).The dural sac areas in UBE group before operation and 3 days after operation were(66.7±7.7)and(102.8±6.6)mm^(2),respectively,and those in large-channel endoscopy group were(67.1±7.7)and(97.2±6.4)mm^(2),respectively.The dural sac area in UBE group at 3 days after operation was better than that in large-channel endoscopy group(P<0.05).Conclusion Both UBE technology and large-channel endoscopic technology could achieve satisfactory therapeutic effects in the treatment of LSS.However,UBE has more thorough decompression and area of dural sac expansion is better than that of the large-channel.