李鹏 沈忠达

【摘要】 目的：探討脊柱内镜下单侧椎板间入路双侧椎管减压（Endo-ULBD）在老年性腰椎管狭窄患者中的临床疗效及对并发症发生情况的影响。方法：选取2018年1月-2019年8月70例老年性腰椎管狭窄症患者为研究对象。采用抽签方法分为对照组和观察组，每组35例。对照组采用侧棘突旁小切口入路双侧减压术治疗，观察组采用Endo-ULBD治疗，两组治疗后2周对患者效果进行评估，并完成6个月随访。比较两组治疗效果、手术指标、视觉模拟疼痛（VAS）评分、Oswestry功能障碍指数（ODI）及术后并发症发生情况。结果：观察组术后总有效率为97.1%，高于对照组的71.4%，差异有统计学意义（P<0.05）;观察组手术时间、住院时间均短于对照组，出血量、引流量均少于对照组，差异均有统计学意义（P<0.05）。术后6个月，两组的VAS、ODI评分均低于手术前，且观察组上述评分均低于对照组，差异均有统计学意义（P<0.05）;观察组并发症发生率低于对照组，差异有统计学意义（P<0.05）。结论：Endo-ULBD用于老年性腰椎管狭窄症患者中能获得较高的近期疗效，手术创伤较小，能减轻患者疼痛，改善患者肢体功能，术后并发症发生率较低，值得推广应用。

【关键词】 单侧椎板间入路双侧椎管减压术 老年性腰椎管狭窄症 并发症 功能障碍指数

Effect of Endo-ULBD Treatment on the Clinical Efficacy and Complications of Elderly Patients with Lumbar Spinal Stenosis/LI Peng， SHEN Zhongda. //Medical Innovation of China， 2021， 18（14）： 0-039

[Abstract] Objective： To investigate the clinical efficacy and complications of endoscopy-unilateral laminectomy for bilateral decompression （Endo-ULBD） in elderly patients with lumbar spinal stenosis. Method： A total of 70 patients with senile lumbar spinal stenosis from January 2018 to August 2019 were selected as the research subjects. By drawing lots， they were divided into control group and observation group， 35 cases in each group. The control group was treated with bilateral decompression through a small incision through the lateral paraspinous process， and the observation group was treated with Endo-ULBD. The efficacy of the two groups was evaluated 2 weeks after treatment， and the 6-month follow-up was completed. The therapeutic effect， surgical parameters， visual analog pain （VAS） score， Oswestry disability index （ODI） and postoperative complications were compared between the two groups. Result： The total effective rate of the observation group was 97.1%， which was higher than 71.4% of the control group， the difference was statistically significant （P<0.05）. The operation time and hospitalization time of the observation group were shorter than those of the control group， and the amount of blood loss and drainage volume were less than those of the control group， the differences were statistically significant （P<0.05）. 6 months after surgery， the VAS and ODI scores of both groups were lower than those before surgery， and the above scores of the observation group were lower than those of the control group， the differences were statistically significant （P<0.05）. The complication rate of the observation group was lower than that of the control group， the difference was statistically significant （P<0.05）. Conclusion： Endo-ULBD can achieve high short-term efficacy in patients with senile lumbar spinal stenosis， with less surgical trauma， relieve pain， improve limb function， and lower incidence of postoperative complications， which is worthy of promotion and application.

[Key words] Unilateral laminectomy for bilateral decompression Senile lumbar spinal stenosis Complication Oswestry disability index

First-authors address： Jiamusi Chinese Medicine Hospital， Jiamusi 154002， China

doi：10.3969/j.issn.1674-4985.2021.14.009

腰椎管狭窄症好发于老年人群中，是由于椎管内骨性结缔组织或者是纤维结缔组织发生异常增生而导致的神经根、腰椎硬膜囊压力，临床多表现为间歇性跛行、腰腿痛等[1]。既往研究表明：腰椎管狭窄症多发生在40岁以上人群中，且患者发病早期临床症状缺乏典型性，随着病情不断发展或患者适当的运动后，将会引起下肢麻木、疼痛等，影响患者健康、生活[2-4]。侧棘突旁小切口入路双侧减压术是腰椎管狭窄症患者中常用的治疗方法，虽然能改善患者症状，但是手术创伤较大、风险性较高，导致患者治疗預后较差。脊柱内镜下单侧椎板间入路双侧椎管减压（Endo-ULBD）属于是一种微创治疗方法，更加符合和遵循微创内镜手术的基本原则，保留了部分关节突关节及脊柱后方韧带复合体的完整性，且不会影响脊柱的稳定性，达到广泛的减压效果，避免了内固定。……