椎间孔镜BEIS技术与微创通道髓核摘除治疗腰椎间盘突出症的比较  

Comparison of Percutaneous Spinal Endoscopic BEIS Technique and Discectomy by Minimally Invasive Channel System for Lumbar Disc Herniation

作　　者：丁寅 赵国辉[1] 陈孜[1] 张云坤[1] 徐南伟[1] Ding Yin;Zhao Guohui;Chen Zi(Department of Orthopedics, Second People’s Hospital of Changzhou, Changzhou 213000, China)

机构地区：[1]江苏省常州市第二人民医院骨科,常州213000

出　　处：《中国微创外科杂志》2020年第8期721-725,共5页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的比较经皮椎间孔镜“广泛-简单-直接”技术(broad easy immediate surgery,BEIS)与微创通道髓核摘除技术治疗腰椎间盘突出症的疗效。方法回顾性分析我院2016年5月~2018年8月89例因腰椎间盘突出症行微创手术的患者资料,其中BEIS手术55例,微创通道手术34例。比较2组手术时间、术后并发症。术前、术后3天、术后3个月、术后1年以及末次随访采用视觉模拟评分(Visual Analogue Scale,VAS)评估腰腿痛程度,Oswestry功能障碍指数(Oswestry Disability Index,ODI)评估腰椎功能,术后1年用改良MacNab标准评估疗效。采用腰椎正侧位片及动力位片评估术前、术后1年手术节段椎间盘高度以及腰椎稳定性。结果BEIS组手术时间[(123.0±50.6)min]明显长于微创通道组[(56.5±19.1)min](t=8.791,P=0.000)。术后2组各个时间点VAS和ODI均较术前明显改善(P<0.05),且术后3天BEIS组明显优于微创通道组(P<0.05),其他时点2组差异无显著性(P>0.05)。术后1年BEIS组MacNab优良率为90.9%(50/55),微创通道组为88.2%(30/34),差异无显著性(χ^2=0.002,P=0.964)。2组术后1年椎间隙高度较术前均明显下降(P<0.05),2组下降百分比差异无显著性(P>0.05)。2组术后1年腰椎不稳发生率差异无显著性(P>0.05)。结论椎间孔镜BEIS技术和微创通道髓核摘除术治疗腰椎间盘突出症均能取得满意的效果。相对于微创通道髓核摘除术,BEIS手术需要更长的手术时间,但术后短时间内临床效果更好。Objective To compare the clinical efficacy between the percutaneous spinal endoscopic surgery with the technique of broad easy immediate surgery(BEIS)and minimally invasive channel system for the treatment of lumbar disc herniation.Methods From May 2016 to August 2018,89 patients underwent surgical treatment for lumbar disc herniation in our hospital,including 55 cases of BEIS surgery and 34 cases of discectomy with the assist of minimally invasive channel system.The operation time and postoperative complications were compared.The Visual Analogue Scale(VAS),Oswestry Disability Index(ODI)and MacNab criteria were used to compare the clinical efficacy of the two groups at before surgery,and at 3 days,3 months and 1 year after the surgery.The X-ray of the lumbar spine was used to assess the disc height and stability of the lumbar spine at preoperative and postoperative time points.Results The operation time was significantly longer in the BEIS surgery group[(123.0±50.6)min]compared to the minimally invasive channel system group[(56.5±19.1)min,t=8.791,P=0.000].The VAS score and ODI were significantly improved in both groups at each time points after surgery(P<0.05).The BEIS surgery group had significantly lower VAS score and ODI compared to the minimally invasive channel system group at 3 days postoperatively(P<0.05).There were no significant differences in the VAS score and ODI between the two groups at the other follow-up time points(P>0.05).The excellent and good rate was 90.9%(50/55)in the BEIS surgery group and 88.2%(30/34)in the minimally invasive channel system group according the the MacNab criteria(χ^2=0.002,P=0.964).The disc height at 1 year after surgery was significantly decreased in both groups compared with that before surgery(P<0.05),and the percentage of decrease was not significant between the two groups(P>0.05).There was no significant difference in the incidence of lumbar instability at 1 year after surgery between the two groups(P>0.05).Conclusions Both the BEIS surgery and the minimally invasiv

关 键 词：腰椎间盘突出症 椎间盘摘除 椎间孔镜 BEIS技术 微创通道 

分 类 号：R68[医药卫生—骨科学]