Zhang Zhiwu, Shao Jiashen, Liu Shuning, Meng Hai, Fan Zihan, Lin Jisheng, Li Xiang, Fei Qi
Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Orthop Surg. 2025 Sep;17(9):2699-2707. doi: 10.1111/os.70117. Epub 2025 Jul 21.
Unilateral biportal endoscopy with unilateral laminotomy for bilateral decompression (UBE-ULBD) is a widely utilized minimally invasive surgical technique for treating lumbar spinal stenosis (LSS). This study aimed to evaluate the effectiveness of the enhanced recovery after surgery (ERAS) clinical pathway in improving perioperative and short-term clinical outcomes for patients undergoing UBE-ULBD for LSS.
A retrospective cohort study was conducted on the clinical data of patients who underwent UBE-ULBD surgery for LSS from May 2022 to April 2024. Since the implementation of the ERAS clinical pathway in our department in May 2023, all eligible patients were divided into the ERAS group (May 2023-April 2024) and the traditional group (May 2022-April 2023). The two groups were analyzed for Visual Analog Scale (VAS) scores for lower extremities at preoperative, 6, 24, and 48 h postoperatively and on the day of discharge. In addition, the Oswestry Disability Index (ODI) and walking distances were assessed preoperatively, at 3 months postoperatively, and at 6 months postoperatively. Other parameters evaluated included the time to first ambulation after surgery, total length of hospital stay (LOS), postoperative LOS, perioperative opioid consumption, postoperative rehydration volume, and the incidence of postoperative complications.
Compared to the traditional group, patients in the ERAS group demonstrated significantly lower pain scores at 6 and 24 h postoperatively, earlier ambulation, shorter total LOS and postoperative LOS, reduced postoperative rehydration volume, and perioperative opioid application (p < 0.05). No statistically significant differences were observed between the two groups in terms of lower extremities VAS scores before surgery, at 48 h postoperatively, and on the day of discharge. No statistically significant differences were observed in ODI scores before surgery, at 3 months postoperatively, and at 6 months postoperatively, as well as walking distances (p > 0.05). Furthermore, the incidence of complications was comparable between the two groups (p > 0.05).
The UBE-ULBD surgery under the guidance of the ERAS program, through multidisciplinary collaboration and comprehensive measures, can significantly optimize perioperative management, improve postoperative recovery quality, and achieve satisfactory perioperative and short-term clinical outcomes.
单侧双通道内镜下单侧椎板切开双侧减压术（UBE-ULBD）是治疗腰椎管狭窄症（LSS）广泛应用的微创手术技术。本研究旨在评估术后加速康复（ERAS）临床路径对接受UBE-ULBD治疗LSS患者围手术期及短期临床结局的改善效果。
对2022年5月至2024年4月接受UBE-ULBD手术治疗LSS患者的临床资料进行回顾性队列研究。自2023年5月本科室实施ERAS临床路径以来，所有符合条件的患者分为ERAS组（2023年5月至2024年4月）和传统组（2022年5月至2023年4月）。分析两组患者术前、术后6、24和48小时以及出院当天的下肢视觉模拟评分（VAS）。此外，术前、术后3个月和术后6个月评估Oswestry功能障碍指数（ODI）和步行距离。评估的其他参数包括术后首次下床活动时间、总住院时间（LOS）、术后住院时间、围手术期阿片类药物消耗量、术后补液量以及术后并发症发生率。
与传统组相比，ERAS组患者术后6和24小时疼痛评分显著更低，下床活动更早，总住院时间和术后住院时间更短，术后补液量减少，围手术期阿片类药物应用减少（p<0.05）。两组术前、术后48小时及出院当天下肢VAS评分无统计学显著差异。术前、术后3个月及术后6个月的ODI评分以及步行距离无统计学显著差异（p>0.05）。此外，两组并发症发生率相当（p>0.05）。
在ERAS方案指导下的UBE-ULBD手术，通过多学科协作和综合措施，可显著优化围手术期管理，提高术后恢复质量，并取得满意的围手术期及短期临床结局。
