Clinical Study Of Unilateral Biportal Endoscopic Lumbar Spinal Decompression Combined With Bushen Zhuangjin Decoction In The Treatment Of Degenerative Lumbar Spinal Stenosis Due To Liver-Kidney Deficiency

Objective To observe the efficacy of unilateral biportal endoscopic（UBE）unilateral laminotomy biportal decompression（ULBD）combined with Bushen Zhuangjin decoction（BZD）in the treatment of degenerative lumbar spinal stenosis（DLSS）due to Liver-Kidney Deficiency,and compare it with simple UBE-ULBD or microscopic ULBD surgery（MicroULBD）to explore the clinical value of UBE-ULBD combined with traditional Chinese medicine in the treatment of DLSS due to Liver-Kidney Deficiency.Methods DLSS cases due to Liver-Kidney Deficiency treated in Hangzhou Hospital of traditional Chinese Medicine from December 2019 to January 2021 were collected and divided into Micro-ULBD group（n=30）,UBE-ULBD group（n=30）and UBE combined with BZD group（n=30）.The clinical efficacy was evaluated by visual analogue pain score（VAS）,Oswestry disability index（ODI）and modified MacNab criteria.The enlarged cross-sectional area of dural sac and the proportion of facet joint preservation were calculated by MRI and CT.The degree of injury was evaluated by the changes of serum Hemoglobin（Hb）and C-reactive protein（CRP）after operation.Results（1）There was no significant difference in surgical levels,sex,age,body mass index and the incidence of underlying diseases（hypertension and diabetes）among the three groups（P>0.05）.（2）Compared with the UBE-ULBD group and the UBE combined with BZD group,the Micro-ULBD group had more blood loss,longer operation time and longer postoperative hospital stay,and the difference was statistically significant（P<0.05）.（3）The VAS and ODI score of the three groups were improved in different degrees at 1 month,3 months and 6 months after operation.At 1 month after operation,the VAS and ODI score of UBE combined with BZD group were better than those of Micro-ULBD group and UBE-ULBD group（P<0.05）.At 3 months after operation,the VAS score of the UBE combined with BZD group was better than that of the Micro-ULBD group,and the ODI score of the UBE combined with BZD group was better than that of the Micro-ULBD group and the UBE-ULBD group（P<0.05）.At 6 months after operation,there was no significant difference in the VAS score among the three groups（P>0.05）,but the ODI score in the UBE combined with BZD group was better than that in the Micro-ULBD group（P<0.05）.At the last follow-up,the curative effect was evaluated according to the modified MacNab criteria,and the excellent and good rate of UBE combined with BZD group was better than that of Micro-ULBD group（P<0.05）.（4）There was no significant difference in the enlarged cross-sectional area of dural sac among the three groups（P>0.05）.The proportion of ipsilateral and contralateral facet joint preservation in Micro-ULBD group was lower than that in UBE group and UBE combined with BZD group（P<0.05）.（5）There was no significant difference in serum Hb and CRP among the three groups before operation.Compared with the difference of Hb before and after operation,the Hb in Micro-ULBD group decreased more after operation,and there was significant difference compared with the other two groups（P<0.05）.The serum CRP and the difference of CRP before and after operation in Micro-ULBD group were significantly higher than those in the other two groups（P<0.05）.Conclusion UBE-ULBD surgery could obtain a good clinical effect for the treatment of DLSS,with complete decompression,less bleeding,less surgical injury,shorter postoperative hospital stay and less impact on postoperative spinal stability.BZD could improve the clinical efficacy of UBE-ULBD in the treatment of DLSS due to Liver-Kidney Deficiency,which was helpful to relieve pain and improve lumbar function after operation.