陆军军医大学学报2026，Vol.48Issue(16)：2310-2319,10.DOI:10.16016/j.2097-0927.202604102
三个减压边界内的单/双通道内镜减压术治疗退行性腰椎管狭窄症的临床疗效对比:一项回顾性队列研究
Comparative efficacy of uniportal and biportal endoscopic decompression within 3 decompression boundaries for degenerative lumbar spinal stenosis:a retrospective cohort study
摘要
Abstract
Objective To compare the clinical and radiological outcomes of uniportal endoscopic unilateral laminotomy for bilateral decompression(UE-ULBD)versus biportal endoscopic unilateral laminotomy for bilateral decompression(BE-ULBD)within 3 predefined decompression boundaries for degenerative lumbar spinal stenosis(DLSS).Methods This study adopted a retrospective cohort study design.Medical records of DLSS patients who underwent UE-ULBD or BE-ULBD at the Department of Orthopedics,Daping Hospital,Army Medical University from January 2022 to October 2023 were collected.After applying inclusion and exclusion criteria,69 patients who completed follow-up and had complete medical records were enrolled and divided into 2 groups according to surgical approach:the UE-ULBD group(n=34)and the BE-ULBD group(n=35).All patients had more than 6 months of follow-up,with a mean follow-up duration of(9.84±2.25)months.Three decompression boundaries were strictly followed intraoperatively.Clinical outcomes were assessed using VAS and ODI;operative time was also recorded.Radiological outcomes were evaluated by measuring the dural sac cross-sectional area,multifidus cross-sectional area,medial facet angle,facet joint width,and articular surface length on imaging.Results No statistically significant differences were found between the two groups in demographic parameters including age,sex,disease duration,surgical approach side,and surgical segment.ODI and VAS scores improved significantly in both groups compared with preoperative values(P<0.05).The BE-ULBD group had a shorter operative time than the UE-ULBD group(P<0.001),whereas the latter showed significantly less postoperative paraspinal multifidus swelling(15.41±7.20 vs 111.3±26.08 mm²,P<0.001).No statistically significant differences were observed between the two groups in dural sac expansion area(90.29±16.07 vs 92.83±11.93 mm²,P=0.459),bilateral medial facet angle increase(ipsilateral:40.82±4.41 vs 41.47±4.19°,P=0.529;contralateral:16.96±6.81 vs 18.18±5.05°,P=0.401),facet joint articular surface length resection range(ipsilateral:2.17±1.06 vs 2.64±1.01 mm,P=0.061;contralateral:1.38±0.64 vs 1.41±0.77 mm,P=0.838),or facet joint width resection range(ipsilateral:1.98±1.02 mm vs 1.87±1.01 mm,P=0.678;contralateral:2.02±1.07 vs 2.07±0.66 mm,P=0.833).Conclusion When three decompression boundaries are strictly adhered to intraoperatively,both UE-ULBD and BE-ULBD can achieve equivalent radiological decompression effects and similar facet joint resection rates,with both yielding good clinical outcomes.BE-ULBD offers higher surgical efficiency,whereas UE-ULBD causes less paraspinal soft tissue damage.关键词
单通道内镜/双通道内镜/单侧椎板切开双侧减压术/减压边界/退行性腰椎管狭窄症Key words
uniportal endoscopy/biportal endoscopy/unilateral laminectomy for bilateral decompression/decompression boundaries/degenerative lumbar spinal stenosis分类
医药卫生引用本文复制引用
蒲俊刚,蓝海洋,廖从刚,刘鹏,郝杰..三个减压边界内的单/双通道内镜减压术治疗退行性腰椎管狭窄症的临床疗效对比:一项回顾性队列研究[J].陆军军医大学学报,2026,48(16):2310-2319,10.基金项目
重庆医科大学第一临床医学院2024届研究生导师团队项目(CYYY-XKDFJH-DSTD-202404) Supported by the 2024 Cohort Graduate Supervisor Team Project of the First Clinical College in Chongqing Medical University(CYYY-XKDFJH-DSTD-202404). （CYYY-XKDFJH-DSTD-202404）
