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OA

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 pa-tients 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 L3,4,38 patients on L4,5,and 21 patients with L5S1.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 u-nilateral 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 L3,4(6 cases),L4,5(18 cases),and L5S1(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 L3,4(5 cases),L4,5(20 cases),and L5S1(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 com-pared.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 extremi-ty 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 statis-tically 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 respec-tively;ODI were(41.00±2.26)％,(32.51±2.93)％,(20.09±2.89)％,(10.71±2.26)％,respectively;JO A 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)mm2,respectively,and those in large-channel endoscopy group were(67.1±7.7)and(97.2±6.4)mm2,respectively.The dural sac area in UBE group at 3 days after operation was better than that in large-channel en-doscopy group(P＜0.05).Conclusion Both UBE technology and large-channel endoscopic technology could achieve satisfacto-ry 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.