LE-ULBD与传统椎板间开窗技术椎管减压治疗退变性腰椎管狭窄症疗效及对JOA、Oswestry评分和ROM的影响

摘要 目的：探讨腰椎内镜下单侧入路椎板切除双侧减压术（LE-ULBD）与传统椎板间开窗技术椎管减压治疗退变性腰椎管狭窄症（DLSS）疗效及对JOA评分、ODI评分和关节活动度（ROM）的影响。方法：回顾性选取2019年11月-2022年4月收治的80例DLSS患者，根据手术方法分为研究组（n=40）和对照组（n=40），对照组采用传统椎板间开窗椎管减压术治疗，研究组采用LE-ULBD治疗，比较两组围手术期指标、腰痛和下肢痛的视觉模拟评分（VAS）、JOA评分、Oswestry评分、上下方邻近节段ROM。结果：研究组手术时间、住院时间短于对照组，切口长度小于对照组（t=3.249；t=3.240；t=16.690，P<0.05）；术后1、3个月，研究组腰痛、下肢痛VAS评分低于对照组（t=2.296；t=2.071；t=2.531；t=2.117，P<0.05）；术后1、3个月，研究组JOA评分高于对照组，ODI评分低于对照组（t=3.119；t=2.231；t=3.065；t=2.457，P<0.05）；术后6个月，研究组上下方邻近节段ROM低于对照组（t=5.372；t=6.076，P<0.05）；两组并发症比较，差异无统计学意义（P>0.05）。结论：相较于传统椎板间开窗椎管减压，LE-ULBD治疗DLSS能显著缩短手术时间和住院时间，减少手术创伤，保留上下邻近节段活动度，加快术后腰腿痛缓解及腰椎功能的恢复。

Curative Effect of LE-ULBD and Traditional Fenestration Laminectomy for Spinal Decompression on Degenerative Lumbar Spinal Stenosis and their Influences on JOA, Oswestry Scores and ROM

ABSTRACT Objective: To explore the curative effect of unilateral laminectomy for bilateral decompression with lumbar endoscope (LE-ULBD) and traditional fenestration laminectomy for spinal decompression on degenerative lumbar spinal stenosis (DLSS) and their influences on scores of Japanese Orthopedic Association (JOA) and Oswestry Disability Index (ODI), and range of motion (ROM). Methods: A total of 80 patients with DLSS were retrospectively enrolled as the research objects between November 2019 and April 2022. According to different surgical methods, they were divided into study group (n=40, LE-ULBD) and control group (n=40, traditional fenestration laminectomy for spinal decompression). The perioperative indexes, sores of backache and melosalgia visual analogue scale (VAS), JOA and Oswestry, and ROM of upper and lower adjacent segments were compared between the two groups. Results: The operation time and hospitalization time in study group were shorter than those in control group, and incision length was shorter than that in control group (t=3.249; t=3.240; t=16.690, P<0.05). At 1 and 3 months after surgery, scores of backache and melosalgia VAS in study group were lower than those in control group (t=2.296; t=2.071; t=2.531; t=2.117, P<0.05). At 1 and 3 months after surgery, JOA score in study group was higher than that in control group, and ODI score was lower than that in control group (t=3.119; t= 2.231; t=3.065; t=2.457, P<0.05). At 6 months after surgery, ROM values of upper and lower adjacent segments in study group were lower than those in control group (t=5.372; t=6.076, P<0.05). There was no significant difference in complications between the two groups (P>0.05). Conclusion: Compared with traditional fenestration laminectomy for spinal decompression, LE-ULBD can significantly shorten operation time and hospitalization time, reduce surgical trauma, preserve ROM of upper and lower adjacent segments, and accelerate postoperative relief of lumbar pain and recovery of lumbar function in DLSS.