单侧双通道内镜与椎间盘镜治疗腰椎间盘突出症的临床分析  

Retrospective analysis ofunilateral biportal endoscopic discectomy(UBED)and microendoscopic discectomy(MED)in the treatment of lumbar intervertebral disc herniation

作　　者：王彬 何鹏 刘晓伟 武振方 许斌 WANG Bin;HE Peng;LIU Xiao-wei;WU Zheng-fang;XU Bin(Department of Orthopedics,Jinling Hospital Affiliated to Medical School of Nanjing University/General Hospital of Eastern Theater Command,PLA,Nanjing 210002,Jiangsu,China)

机构地区：[1]南京大学医学院附属金陵医院(东部战区总医院)骨科,南京210002

出　　处：《东南国防医药》2022年第2期142-146,共5页Military Medical Journal of Southeast China

摘　　要：目的比较椎间盘镜(MED)和单侧双通道脊柱内镜(UBED)治疗腰椎间盘突出症的临床疗效、安全性及学习曲线,为单侧双通道脊柱内镜的推广提供经验。方法回顾性分析2020年1月至9月在东部战区总医院接受治疗的腰椎间盘突出症患者100例,其中接受MED治疗患者50例(MED组),男27例,女23例,年龄(45.2±11.0)岁,体重指数(BMI)(24.7±2.1)kg/m^(2),手术节段L4/528例,L5/S122例,症状持续时间(3.8±0.8)年;接受UBED治疗患者50例(UBED组),男26例,女24例,年龄(44.7±14.6)岁,体重指数(BMI)(25.1±3.0)kg/m^(2),手术节段L4/527例,L5/S123例,症状持续时间(4.0±0.2)年。统计2组患者手术时间、术中转为开放手术例数、术中出血量、术前与术后1 d C反应蛋白改变量、术后引流量、手术并发症及住院时间;通过比较术前、术后1 d、术后3个月、术后6个月及术后12个月时腰腿痛视觉模拟评分(VAS),术前、术后3个月、术后6个月及术后12个月时Oswestry功能障碍指数(ODI)和术后12个月时改良Macnab标准评价2组患者的临床疗效。结果UBED组在术后1 d腰背痛VAS评分低于MED组(P<0.05);UBED组和MED组的手术时间分别为80(78~87.5)min和70(60~80)min(P<0.05),术后引流量分别为(31.2±28.3)mL和(27.4±20.4)mL(P<0.05),手术前后C反应蛋白改变量分别为(13.1±14.4)mg和(17.4±3.3)mg/L,(P<0.05),住院时间分别为(4.3±2.5)d和(7.6±2.5)d(P<0.05),术中转为开放式手术次数分别为5次和1次(P<0.05),其余指标差异均无统计学意义(P>0.05)。UBED组在手术例数到14例时手术时间达到总体中位数,而MED组需要23例,UBED组学习周期短于MED组。结论在治疗腰椎间盘突出症时,UBED虽然创伤较大,但学习周期短、短期疗效显著,术后并发症发生率也更低,而在长期随访中,两者均有较好的治疗效果。Objective To compare the clinical efficacy,safety and learning curve of microendoscopic discectomy(MED)and unilateral biportal endoscopic discectomy(UBED)in the treatment of lumbar disc herniation And to provide experience in the promotion of spinal endoscopy.Methods From January 2020 to September 2020,100 patients with lumbar disc herniation who were treated in our hospital and 50 patients who received MED treatment were retrospectively analyzed,including 27 males and 23 females,age was 45.2±11.0 years old,body mass index(BMI)was(24.7±2.1)kg/m 2,28 cases were operated at L4/5,22 cases were L5/S1,and the symptom duration was(3.8±0.82)years.50 patients received UBED treatment,including 26 males and 24 females,age(44.7±14.6)years old,body mass index(BMI)(25.1±3.0)kg/m 2,27 cases of surgical segment L4/5,23 cases of L5/S1,symptom duration(4.0±0.2)years.The operation time,number of cases converted to open surgery during operation,intraoperative blood loss,change of C-reactive protein before operation and 1 day after operation,postoperative drainage volume,surgical complications and hospitalization time were recorded in the two groups.The visual analogue scale(VAS)of low back and leg pain at 1 day after operation,3 months after operation,6 months after operation and 12 months after operation,before operation,3 months after operation,and 6 months after operation.The Oswestry disability index(ODI)at 12 months after surgery and the modified Macnab criteria at 12 months after surgery were used to evaluate the clinical efficacy of the two groups of patients.Results The VAS score of low back pain in UBED group was lower than that in MED group 1 day after operation(P<0.05).The operation time of UBED group and MED were 80(78-87.5)mins and 70(60-80)mins,respectively(P<0.05).The postoperative drainage volume were(31.2±28.3)mL and(27.4±20.4)mL(P<0.05).And the changes of C-reactive protein before and after surgery were(13.1±14.4)mg and(17.4±3.3)mg/l(P<0.05).The length of hospital stay was(4.3±2.5)d and(7.6±2.5)d(P<0.0

关 键 词：腰椎间盘突出症 微创手术 单侧双通道脊柱内镜 椎间盘镜 

分 类 号：R687.3[医药卫生—骨科学]