单侧双通道内窥镜技术与椎板开窗椎间盘切除术治疗单节段腰椎椎间盘突出症的疗效比较  

Comparison of unilateral biportal endoscopic technique and fenestration discectomy for treatment of single-segment lumbar disc herniation

作　　者：高速 陆慧 唐瑜[2] Gao Su;Lu Hui;Tang Yu(First Department of Orthopaedics,Chongqing University Jiangjin Hospital,Chongqing 402260,China;Department of Pulmonary and Critical Care Medicine,Chongqing University Jiangjin Hospital,Chongqing 402260,China)

机构地区：[1]重庆大学附属江津医院骨一科,重庆402260 [2]重庆大学附属江津医院呼吸与危重症医学科,重庆402260

出　　处：《脊柱外科杂志》2022年第6期379-384,共6页Journal of Spinal Surgery

摘　　要：目的对比分析单侧双通道内窥镜(UBE)技术与椎板开窗椎间盘切除术(FD)治疗单节段腰椎椎间盘突出症(LDH)的临床疗效。方法2018年1月—2021年6月收治单节段LDH患者89例,其中46例采用UBE技术治疗(UBE组),43例采用FD治疗(FD组)。记录所有患者手术时间、术后卧床时间、住院时间及并发症发生情况。于术前和术后3 d检测空腹静脉血血红蛋白(Hb)和红细胞比容(HCT)。采用疼痛视觉模拟量表(VAS)评分、日本骨科学会(JOA)评分和Oswestry功能障碍指数(ODI)评估腰腿痛程度及腰椎功能。末次随访时采用改良MacNab标准评估临床疗效。结果所有手术顺利完成,所有患者随访(12.21±2.18)个月。UBE组手术时间较FD组长,术后卧床时间、住院天数较FD组短,术后3 d Hb及HCT水平较FD组高,差异均有统计学意义(P<0.05)。2组术后各时间点腰腿痛VAS评分、JOA评分、ODI较术前显著改善,差异均有统计学意义(P<0.05)。UBE组术后各时间点腰痛VAS评分低于FD组,差异均有统计学意义(P<0.05)。UBE组术后1周腿痛VAS评分低于FD组,差异有统计学意义(P<0.05);其余时间点2组腿痛VAS评分差异无统计学意义(P>0.05)。2组术后各时间点JOA评分和ODI差异无统计学意义(P>0.05)。末次随访时采用改良MacNab标准评价疗效,UBE组疗效优良率为93.48%,FD组为88.37%,差异无统计学意义(P>0.05)。UBE组术后并发症发生率为6.52%,FD组为20.93%,差异有统计学意义(P<0.05)。结论采用UBE技术或FD治疗单节段LDH均能获得满意疗效,UBE较FD具有创伤小、出血量少、卧床时间短、术后恢复快、并发症发生率低等优势,值得临床推广。Objective To compare the clinical efficacy of unilateral biportal endoscopic(UBE)technique and fenestrated discectomy(FD)in the treatment of single-segment lumbar disc herniation(LDH).Methods From January 2018 to June 2021,89 patients with single-segment LDH were admitted to Jiangjin Hospital Affiliated to Chongqing University,of which 46 were treated with UBE(UBE group)technique and 43 with FD(FD group).The operation time,postoperative bed rest time,hospital stay and complications were recorded of all the patients.The fasting venous hemoglobin(Hb)and hematocrit(HCT)were detected before operation and 3 d after operation.The pain visual analog scale(VAS)score,Japanese Orthopaedic Association(JOA)score and Oswestry disability index(ODI)were used to evaluate the intensity of low back and leg pain and lumbar function.The modified MacNab criteria were used to evaluate the therapeutic effect at the final follow-up.Results All the operations were successfully completed,and the patients were followed up for(12.21±2.18)months.The operation time in the UBE group was longer than that in the FD group,the postoperative bed rest time and hospital stay were shorter than those in the FD group,the levels of Hb and HCT at postoperative 3 d were higher than those in the FD group,all with a significant difference(P<0.05).The VAS score of low back and leg pain,JOA score and ODI in both groups at each follow-up time point were significantly improved compared with those before operation(P<0.05).The VAS scores of low back pain at each follow-up time point in the UBE group were lower than those in the FD group,and the differences were statistically significant(P<0.05).The VAS score of leg pain at 1 week after operation in the UBE group was lower than that in the FD group,and the difference was statistically significant(P<0.05);and there was no significant difference in the VAS score of leg pain at other follow-up time points between the 2 groups(P>0.05).There was no significant difference in JOA score and ODI at each follow-up time poin

关 键 词：腰椎 椎间盘移位 内窥镜检查 椎间盘切除术 外科手术 微创性 

分 类 号：R687.3[医药卫生—骨科学]