[Comparative study of decompression of unilateral biportal endoscopic compared to laminectomy with fusion and internal fixation in the treatment of severe lumbar spinal stenosis].

Objective: To compare the clinical efficacy of unilateral biportal endoscopy unilateral laminotomy for bilateral decompression (UBE-ULBD) to posterior lumbar interbody fusion (PLIF) in the treatment of severe lumbar spinal stenosis (SLSS). Methods: The clinical data of 64 patients with SLSS treated with PLIF and UBE-ULBD in Dalian Central Hospital Affiliated to Dalian Medical University from April 2018 to April 2021 were collected and divided into UBE group and PLIF group according to the different surgical procedures. There were 30 cases in the UBE group, including 12 males and 18 females, aged (69.8±6.8) years. There were 34 patients in the PLIF group, including 15 males and 19 females, aged (69.3±6.3) years. The operation time, intraoperative blood loss, surgical complications, the volume of drainage, transfusion, post-operative bed rest time, postoperative hospital stay, surgical costs of both groups were recorded and analyzed. The visual analogue scales (VAS) of back/leg pain (pre-operation and 1 d, 1 month, 6 month, 12 month post-operation) and Oswestry disability index (ODI) (pre-operation and 1 month, 6 month, 12 month post-operation) were used to determine the outcome. And the dural sac cross-sectional area (DSCA) and Schizas grade of both groups preoperatively and 6 month postoperatively were recorded. Results: The operation time in the UBE group was (69.2±8.0) min, it was lower than that in the PLIF group (139.0±15.3) min (P<0.05). The intraoperative blood loss and drainage in the UBE group were (19.5±5.6) ml and (15.0±10.8) ml, which were both lower than those in the PILF group [(212.4±34.1) ml and (169.6±43.8) ml] (both P<0.05). The postoperative bed rest time and hospital stay in the UBE group were (1.8±0.7) days and (3.0±0.9) days, which were both shorter than those in the PLIF group [(4.5±1.4) days and (7.1±1.7) days] (both P<0.05). The surgical cost was also lower in the UBE group than that in the PLIF group [RMB,(18.4±1.0) thousands yuan vs (33.9±2.4) thousands yuan, P<0.05]. In addition, no patient received blood transfusion in the UBE group. Dural sac tear occurred in 2 cases in the UBE group and in 3 cases in PLIF group; nerve root injury and infection occurred in one case in the PLIF group, respectively. In the PLIF group, the VAS of back pain was not significantly improved 1 day after operation when compared with that before the operation, but it significantly improved 1 month, 6 months and 1 year after operation (all P<0.05). The VAS for back pain at 1 day after operation and ODI at 1 month after operation in the UBE group were significantly superior to those in the PLIF group (both P<0.05), while there was no significant difference between the two groups in the VAS for back pain at 1 month, 6 months and 1 year after operation and ODI at 6 months and 1 year after operation. Both groups got significant canal expansion after the surgery and the PLIF group showed larger canal expansion extent (all P<0.05). Both groups improved significantly after surgery in the Schizas grade, there were 25 cases in UBE group improved to grade A, 5 cases to grade B while 30 cases in PLIF group improved to grade A, 4 cases to grade B, but there was no significant difference between the two groups (P>0.05). Conclusion: ULBD-UBE could achieve full decompression of the whole spinal canal with limited structures damage in treating SLSS. Compared with PLIF, UBE-ULBD could get complete decompression as well as less iatrogenic damage, it may be an ideal alternative surgical technique for SLSS with less invasion.目的： 比较单侧双通道内镜（UBE）下行单侧椎板切开双侧减压（ULBD）与后路腰椎椎体间融合术（PLIF）治疗重度腰椎管狭窄症的临床疗效。 方法： 收集大连医科大学附属大连市中心医院2018年4月至2021年4月通过PLIF和UBE-ULBD治疗的64例重度腰椎管狭窄症患者的临床资料，根据接受手术术式的不同分为UBE组和PLIF组。UBE组30例，男12例，女18例，年龄（69.8±6.8）岁；PLIF组34例，男15例，女19例，年龄（69.3±6.3）岁。记录分析两组的手术时间、术中出血量、手术并发症、术后引流量、是否输血、术后下地时间、术后出院时间、手术成本情况。记录两组术前、术后1 d、1个月、6个月和1年的腰/腿疼痛视觉模拟评分（VAS），术前、术后1个月、6个月和1年的Oswestry功能障碍指数（ODI），术前和术后6个月MRI下硬膜囊横截面积（DSCA）及Schizas标准分级。 结果： UBE组手术时间为（69.2±8.0）min，低于PLIF组的（139.0±15.3）min（P<0.05）；UBE组术中和术后出血量为（19.5±5.6）和（15.0±10.8）ml，低于PILF组的（212.4±34.1）和（169.6±43.8）ml（均P<0.05）；UBE组术后下地时间和术后出院时间为（1.8±0.7）和（3.0±0.9）d，低于PLIF组的（4.5±1.4）和（7.1±1.7）d（均P<0.05）；UBE组手术费用也低于PLIF组［人民币（1.84±0.10）万元比（3.39±0.24）万元，P<0.05］，且UBE组无输血病例；UBE组2例发生硬膜囊破裂，PLIF组3例出现硬膜囊破裂、1例神经根损伤和1例感染。UBE组术后的腰疼VAS评分均较术前改善（均P<0.05），而PLIF组术后1 d腰疼VAS评分较术前无明显改善，但术后1个月、6个月及1年均较术前改善（均P<0.05）；UBE组术后1 d腰疼VAS评分和术后1个月ODI优于PLIF组（均P<0.05），而两组术后1个月、6个月和1年的腰疼VAS评分和术后6个月和1年的ODI差异均无统计学意义（均P>0.05）。两组术后DSCA均较术前扩大（均P<0.05），PLIF组术后DSCA较UBE组更大（P<0.05）；Schizas标准分级上，UBE组术后25例恢复至A级，5例至B级，PLIF组术后30例恢复至A级，4例恢复至B级，两组术后椎管狭窄程度均较术前改善，两组间差异无统计学意义（P>0.05）。 结论： UBE-ULBD在治疗重度腰椎管狭窄症时能够实现全椎管减压，与PLIF相比，医源性创伤更小，是治疗重度腰椎管狭窄症的一种安全有效的微创手术方式。.