Objective: To analyze and compare the clinical efficacy of unilateral biportal endoscopic(UBE) decompression and extended interlaminar fenestration for lumbar lateral recess stenosis. Methods: A retrospective analysis of 103 patients treated with UBE decompression or extended interlaminar fenestration for lumbar lateral recess stenosis from July 2017 to June 2020 in the Second Hospital of Anhui Medical University was performed. Eighty patients aged 40 to 86 (63.2±9.8) years were included in this study, including 42 males and 38 females. Forty patients received UBE decompression (UBE group) and 40 patients received extended interlaminar fenestration (fenestration group). Operative time, length of incision, hospital stay and complications were recorded. The visual analogue scale (VAS) scores of low back pain and leg pain and Oswestry dysfunction index (ODI) scores were recorded preoperatively and at 1, 3 and 6 months after the operation and at the final follow-up, and the modified Macnab scale was used to evaluate the clinical efficacy at the final follow-up. Results: Patients in both groups successfully received lumbar lateral recess decompression and were followed up for (12.9±5.4) months in the UBE group and (14.9±3.5) months in the fenestration group, respectively. The operation time in the UBE group was (63.9±11.6) min, it was higher than that in the fenestration group ((54.1±9.2) min, P<0.001). The average incision length in the UBE group was (18.2±1.7) mm, it was lower than that in the fenestration group ((73.5±11.6) mm, P<0.001). Postoperative hospital stay in the UBE group was (4.1±2.2) d, it was lower than that in the fenestration group ((7.6±3.1) d, P<0.001). VAS scores of low back pain were improved after operation in both groups. Low back pain VAS scores of UBE group were lower than those in fenestration group at 1 and 3 months post operation (both P<0.05). The VAS scores of lower limb pain were improved after operation in both groups and there was no statistically significant difference between the two groups at postoperative 1, 3, 6 months after the operation and at the last follow-up (all P>0.05). ODI scores were improved after operation in both groups. ODI scores of UBE group were lower than those in fenestration group at postoperative 1 month and 3 months(both P<0.05). Intraoperative dural tear occurred in 2 cases(5.0%) in the UBE group and 1 case(2.5%) in the fenestration group, with no statistically significant difference between the two groups (P=0.556). According to the modified Macnab scale at the last follow-up, 35 cases were excellent, 3 cases were good, and 2 cases were fair in the UBE group, and 37 cases were excellent, 2 cases were good, and 1 case was fair in the open group. The difference was not statistically significant between the two groups (P=0.745). Conclusion: Compared with the extended interlaminar fenestration, UBE technique can not only reduce the early postoperative low back pain, shorten hospital stay, but also achieve the same long-term clinical efficacy with less trauma.
目的： 分析比较单边双通道内镜下椎管减压术和椎板间扩大开窗术治疗腰椎侧隐窝狭窄症的疗效。 方法： 回顾性分析2017年7月至2020年6月因腰椎侧隐窝狭窄症在安徽医科大学第二附属医院行单边双通道内镜技术或椎板间扩大开窗术治疗的103例患者的临床资料。共纳入80例，男42例，女38例，年龄40~86（63.2±9.8）岁。其中40例患者接受单边双通道内镜减压术（UBE组），40例患者接受椎板间扩大开窗术（开窗组）。记录两组手术时间、切口长度、术后住院时间和并发症情况。记录两组术前及术后1、3、6个月和末次随访时腰痛、下肢痛的疼痛视觉模拟评分（VAS）和Oswestry功能障碍指数（ODI），末次随访时采用改良MacNab标准来评价临床疗效。 结果： 两组患者均顺利完成腰椎侧隐窝狭窄减压，均获得随访，UBE组随访时间为（12.9±5.4）个月，开窗组为（14.9±3.5）个月。UBE组手术时间为（63.9±11.6）min，高于开窗组的（54.1±9.2）min（P<0.001）。UBE组手术切口长度为（18.2±1.7）mm，低于开窗组的（73.5±11.6）mm（P<0.001）。UBE组术后住院时间为（4.1±2.2）d，低于开放组的（7.6±3.1）d（P<0.001）。两组术后各随访时间点腰痛VAS评分均较术前改善，腰痛VAS评分在术后1和3个月时UBE组低于开窗组（均P<0.05）。两组术后各随访时间点下肢痛VAS评分均较术前改善，两组下肢痛VAS评分在术后1、3及6个月和末次随访时差异均无统计学意义（均P>0.05）。两组术后各随访时间点ODI评分均较术前改善，术后1和3个月UBE组低于开窗组（均P<0.05）。UBE组和开窗组分别出现2例（5.0%）和1例（2.5%）术中硬膜囊破裂，两组发生率差异无统计学意义（P=0.556）。末次随访时根据改良MacNab标准，UBE组优35例，良3例，可2例，开放组优37例，良2例，可1例，两组差异无统计学意义（P=0.745）。 结论： 相比于椎板间扩大开窗技术，UBE技术不仅能够减轻术后早期腰背痛，缩短住院时间，且创伤小，并可获得同样的远期疗效。.