摘要
目的探讨单侧双通道内镜(UBE)技术治疗腰椎融合术后邻椎病的短期临床疗效。方法回顾性分析2020年3月至2023年1月于我院应用UBE技术治疗并术后随访时间超过3个月的21例腰椎融合术后邻椎病患者的临床资料。记录患者手术时间、术前1 d与术后1 d血红蛋白降低值、术区引流量、卧床时间及并发症情况。使用日本骨科协会(JOA)评分于术前1 d、术后3 d、术后3个月进行腰椎功能评估,明确改善情况。使用视觉模拟量表(VAS)评分于术前1 d、术后3 d、术后3个月评估下肢疼痛情况。结果手术时间60~175 min,平均(95.38±18.64)min;血红蛋白降低值2~6 g/L,平均(1.42±0.18)g/L;卧床时间27~88 h,平均(36.42±15.33)h;术区引流量50~315 mL,平均(85.56±15.65)mL;术中出现硬膜撕裂1例,转行开放手术修补硬膜囊。术前VAS评分与术后3 d、术后3个月比较,差异有统计学意义(P<0.05);术前JOA评分与术后3 d、术后3个月比较,差异有统计学意义(P<0.05)。结论应用UBE技术治疗腰椎融合术后邻椎病疗效确切,具有创伤小、出血少、卧床时间短等优点,但邻近节段退变较重、椎管严重狭窄病例术中可能出现硬膜撕裂,一旦出现应积极修补,避免马尾神经疝出崁顿坏死,必要时转行开放手术。
Objective To evaluate the short-term clinical efficacy of unilateral biportal endoscopic(UBE)technique in the treatment of adjacent segment disease after lumbar interbody fusion.Methods The clinical data of 21 patients with adjacent segment disease after lumbar interbody fusion who treated with UBE technique and followed up for more than 3 months in our hospital from March 2020 to January 2023 were retrospectively analyzed.The operation time,decrease value of hemoglobin 1 day before and after operation,drainage volume of the operation area,time of bed rest and complications were recorded.The Japanese Orthopaedic Association(JOA)score was used to evaluate lumbar function 1 day before operation,3 days and 3 months after operation to determine the improvement.The visual analogue scale(VAS)score was used to evaluate the pain 1 day before operation,3 days and 3 months after operation.Results The operation time was 60~175 minutes,with an average of(95.38±18.64)minutes;the decrease value of hemoglobin was 2~6 g/L,with an average of(1.42±0.18)g/L;the time of bed rest was 27~88 hours,with an average of(36.42±15.33)hours;the drainage volume of the operation area was 50~315 mL,with an average of(85.56±15.65)mL;and one case of dural tear occurred during the operation,who was converted to open surgery for repairing dural sac.There was statistically significant difference in VAS score before operation compared with that 3 days and 3 months after operation(P<0.05).There was statistically significant difference in the JOA score before operation compared with that 3 days and 3 months after surgery(P<0.05).Conclusion UBE technique is effective in the treatment of adjacent segment disease after lumbar interbody fusion,with the advantages of small trauma,little bleeding and short time of bed rest.However,patients with the serious adjacent segment degeneration and severe spinal stenosis may have dural tear during operation.Once it occurs,active repair should be performed to avoid cauda equina herniation and necrosis,or switch to open surgery,if necessary.
作者
孙绍铜
刘军
刘莛予
吴骏
任伟剑
SUN Shao-tong;LIU Jun;LIU Ting-yu;WU Jun;REN Wei-jian(Fifth Department of Orthopedics,Liaoning Provincial People's Hospital,Shenyang Liaoning 110000,China)
出处
《局解手术学杂志》
2024年第7期575-578,共4页
Journal of Regional Anatomy and Operative Surgery
基金
辽宁省自然科学基金(2022-BS-056)。
关键词
脊柱内镜
手术
疗效
微创脊柱外科
并发症
邻椎病
spinal endoscopy
surgery
efficacy
minimally invasive spinal surgery
complications
adjacent segment disease
作者简介
通信作者:任伟剑,E-mail:d8501@lnph.com。
