目的 探讨单侧双通道内镜技术（UBE）治疗后路腰椎融合术后邻椎病(ASD)的短期临床研究。方法 回顾性分析2020年5月至2022年1月本院脊柱外科收治的采用UBE治疗因腰椎退行性疾病行后路腰椎融合术后出现ASD的患者临床资料及随访情况。 结果 符合标准的患者共12例，均顺利完成手术，随访时间为16~36个月，平均(24.3±4.6)个月。手术时间47~83 min，平均(62.9±9.8) min。1例出现神经根刺激症状，予以激素、脱水等对症处理，2 d后患者症状缓解。无其他并发症发生。住院时间5~10 d，平均（6.9±1.6）d。术后3 d、3个月、6个月、12个月及末次随访时，腰痛VAS评分、下肢痛VAS评分、ODI评分均较术前明显下降，差异具有统计学意义（P<0.001）。术后6个月随访时，根据改良MacNab标准评估：优良率为91.67%（11/12）。影像学方面：术后3 d复查MRI可见神经减压彻底；复查腰椎CT示下关节突骨质切除范围至关节面距离3.84~6.93 mm，平均(5.07[±]1.03) mm；峡部骨质保留保留4.85~7.94 mm，平均(5.96[±]0.81) mm；术后3个月及末次随访时，复查腰椎动力位，无椎体失稳，无责任节段复发。 结论 单侧双通道内镜技术治疗后路腰椎融合术后邻椎病，创伤小、手术时间短、患者满意度高、短期疗效明确。
Abstract
Objective To explore the short-term clinical study of unilateral biportal endoscopic (UBE) technique in the treatment of adjacent segment disease (ASD) after posterior lumbar interbody fusion. Methods The clinical data and follow-up of patients admitted to the department of spine surgery using UBE for the treatment of ASD after posterior lumbar interbody fusion from May 2020 to January 2022 were retrospectively analyzed. Results A total of 12 patients who met the criteria were successfully completed the surgery, and the follow-up time ranged from 16 to 36 months, with a mean of (24.3±4.6) months. Surgical time ranged from 47 min to 83 min, with a mean of (62.9±9.8) min. One case developed nerve root irritation symptoms, which were treated with hormones, dehydration and other symptomatic treatments, and the patient's symptoms were relieved after 2 days. No other complications occurred. The length of hospitalization ranged from 5 days to 10 days, with a mean of (6.9±1.6) days. At 3 days, 3 months, 6 months, 12 months and the final follow-up after surgery, the VAS score of low back pain, VAS score of lower limb pain and ODI score were significantly decreased compared with those before surgery, and the difference was statistically significant (P<0.001). At the 6-month postoperative follow-up, the excellent rate was 91.67% (11/12) as assessed by the modified MacNab criteria. In terms of imaging: complete nerve decompression was seen on review MRI at 3 days postoperatively. Review lumbar spine CT showed that the range of osteotomy of the inferior articular eminence to the articular facet distance was (3.84~6.93) mm, with an average of (5.07±1.03) mm. Isthmus bone retention preservation ranged from 4.85 mm to 7.94 mm, with an average of (5.96±0.81) mm. Lumbar spine power position was reviewed at 3 months postoperatively and at the final follow-up visit, and there was no vertebral instability and no responsible segmental recurrence. Conclusions Unilateral biportal endoscopic technique for treating adjacent segment disease after posterior lumbar interbody fusion is less traumatic, shorter operation time, higher patient satisfaction, and clear short-term efficacy.
关键词
单侧双通道内镜技术； /
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后路腰椎融合术； /
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邻椎病
Key words
Unilateral biportal endoscopic; /
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Posterior lumbar interbody fusion; /
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Adjacent segment disease
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