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经皮椎间孔扩大减压术（FETD）与UBE治疗L5S1椎间孔狭窄的疗效：一项对比研究。

Outcomes of FETD versus UBE in the treatment of L5S1 foraminal stenosis: A comparative study.

作者信息

Yang Yao-Chun, Hsieh Min-Hong, Chien Jui-Teng, Liu Keng-Chang, Yang Chang-Chen

机构信息

National Taiwan University School of Medicine, Taiwan.

Department of Orthopedics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, 62247, Taiwan.

出版信息

Heliyon. 2024 Mar 6;10(6):e27592. doi: 10.1016/j.heliyon.2024.e27592. eCollection 2024 Mar 30.

DOI:10.1016/j.heliyon.2024.e27592
PMID:38501004
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10945252/
Abstract

BACKGROUND

The L5S1 level exhibits unique anatomical features compared with other levels. This makes minimally invasive surgery for L5S1 foraminal stenosis (FS) challenging. This study compared the surgical outcomes of full endoscopic transforaminal decompression (FETD) and unilateral biportal endoscopy with the far-lateral approach (UBEFLA) in patients with L5S1FS.

METHODS

In this retrospective study, 49 patients with L5S1FS were divided into two groups. Of these, 24 patients underwent FETD, 25 patients underwent UBEFLA. The study assessed demographic data, leg pain visual analog scale (VAS) score, back pain VAS score, Oswestry Disability Index (ODI), modified MacNab outcome scale, and radiographic parameters including postoperative lateral facet preservation (POLFP).

RESULTS

The Mann-Whitney test revealed that the UBEFLA group exhibited a higher VAS score for back pain at one week after the operation, whereas the FETD group exhibited a higher leg pain VAS score 6 weeks after the operation. All four undesired MacNab outcomes in the FETD group were attributed to residual leg pain, whereas all five undesired MacNab outcomes in the UBEFLA group were due to recurrent symptoms. Radiographically, the FETD group exhibited greater POLFP.

CONCLUSIONS

When L5S1FS is performed, there may be challenges in adequately clearing the foraminal space in FETD. On the other hand, UBEFLA allowed for a more comprehensive clearance. However, this advantage of UBEFLA was associated with spinal instability as a future outcome.

摘要

背景

与其他节段相比，L5S1节段具有独特的解剖学特征。这使得L5S1椎间孔狭窄（FS）的微创手术具有挑战性。本研究比较了全内镜经椎间孔减压术（FETD）和单侧双通道内镜远外侧入路（UBEFLA）治疗L5S1FS患者的手术效果。

方法

在这项回顾性研究中，49例L5S1FS患者被分为两组。其中，24例患者接受FETD，25例患者接受UBEFLA。该研究评估了人口统计学数据、腿痛视觉模拟量表（VAS）评分、背痛VAS评分、Oswestry功能障碍指数（ODI）、改良MacNab疗效评定量表，以及包括术后小关节面保留率（POLFP）在内的影像学参数。

结果

Mann-Whitney检验显示，UBEFLA组术后1周背痛VAS评分较高，而FETD组术后6周腿痛VAS评分较高。FETD组所有四项不良MacNab结果均归因于残留腿痛，而UBEFLA组所有五项不良MacNab结果均归因于症状复发。影像学检查显示，FETD组的POLFP更高。

结论

在进行L5S1FS手术时，FETD在充分清理椎间孔间隙方面可能存在挑战。另一方面，UBEFLA能实现更全面的清理。然而，UBEFLA的这一优势与未来脊柱不稳定的结果相关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d422/10945252/b0a3aefec7be/gr9.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d422/10945252/bcc8befdd964/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d422/10945252/00112c906b5b/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d422/10945252/0dc88fe4a708/gr3.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d422/10945252/b0a3aefec7be/gr9.jpg

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