单侧双通道内镜手术治疗高度游离型腰椎间盘突出症的临床疗效  

Clinical observation of unilateral biportal endoscopy surgery for highly free type lumbar disc herniation

作　　者：朱小建[1] 曹建华[1] 李玉前[2] 王震[2] 丁正美 秦晓东 刘二涛 郭张建 Zhu Xiaojian;Cao Jianhua;Li Yuqian;Wang Zhen;Ding Zhengmei;Qin Xiaodong;Liu Ertao;Guo Zhangjian(Department of Orthopedics,the Fourth People's Hospital of Nantong,Nantong 226001,China;Department of Orthopedics,the Third People's Hospital of Nantong,Nantong 226001,China)

机构地区：[1]江苏省南通市第四人民医院骨科,226001 [2]江苏省南通市第三人民医院骨科,226000

出　　处：《中华解剖与临床杂志》2023年第5期313-319,共7页Chinese Journal of Anatomy and Clinics

基　　金：南通市科技局指导性课题(MSZ21123)。

摘　　要：目的探讨单侧双通道内镜技术(UBE)治疗高度游离型腰椎间盘突出症(LDH)的临床疗效。方法回顾性队列研究。纳入2017年1月—2022年1月南通市第四和第三人民医院骨科接受脊柱内镜手术治疗的L_(4/5)、L_(5)/S_(1)高度游离型LDH 64例,其中男31例、女33例,年龄29~77(55.6±16.5)岁,病变节段L_(4/5)36例、L_(5)/S_(1)28例。64例均接受脊柱内镜辅助下突出髓核摘除术,其中使用经皮椎间孔镜椎间盘切除术(PETD)的32例纳入PETD组,采用UBE治疗的32例纳入UBE组。分别对比2组患者手术时间、术中透视次数、术中出血、住院时间、术后髓核残留,以及术前、术后1天和术后6个月患者腰腿痛视觉模拟评分法(VAS)评分与Oswestry功能障碍指数(ODI),术后6个月采用改良MacNab标准进行疗效评价。结果2组患者基线资料比较差异均无统计学意义(P值均>0.05)。手术时间、术中出血量、住院时间UBE组分别为(70.7±8.8)min、(11.5±2.9)mL、(4.9±1.2)d,PETD组分别为(66.3±11.9)min、(13.0±3.5)mL、(5.0±1.3)d,组间比较差异均无统计学意义(t=1.72、-1.88、-0.32,P值均>0.05)。UBE组术中透视次数为(8.6±2.2)次,少于PETD组的(15.9±4.2)次,差异有统计学意义(t=-8.73,P<0.001)。UBE组无髓核残留;PETD组术后出现2例有症状髓核残留,再次予以孔镜手术摘除残留髓核。2组间患者术前、术后第1天、术后6个月腰腿痛VAS评分和ODI评分差异均无统计学意义(P值均>0.05);UBE组和PETD组患者术后第1天、术后6个月腰腿痛VAS评分和ODI分别与组内术前比较均有明显改善,差异均有统计学意义(P值均<0.001)。术后6个月,UBE组和PETD组疗效优良率分别为93.8%(30/32)和90.6%(29/32),差异无统计学意义(χ^(2)=0.22,P=0.641)。结论对于高度游离型LDH患者,PETD和UBE治疗都是安全有效的。UBE能够直视下摘除髓核、相较PETD能够减少髓核残留概率,明显减少透视次数。Objective This study aimed to discuss the clinical efficacy of unilateral biportal endoscopy in the treatment of highly free-type lumbar disc herniation.Methods A retrospective cohort study was conducted.A total of 64 patients with L_(4/5) and L_(5)/S_(1) highly free-type lumbar disc herniation were selected from January 2017 to January 2022,including 31 males and 33 females,aged 29-77(55.6±16.5)years,who were treated by spinal endoscopy at the Orthopedics Department of Nantong the Fourth and the Third People's Hospital.The involved segments included L_(4/5) and L_(5)/S_(1) with 36 and 28 patients,respectively.All 64 patients received endoscopic-assisted removal of herniated nucleus pulposus.Among them,32 patients who used PELD were included in the PELD group,and 32 patients who used UBE were included in the UBE group.The operation time,times of intraoperative fluoroscopy,intraoperative bleeding,hospital stay,and postoperative residual nucleus pulposus,as well as visual analog scale(VAS)score and Oswestry disability index(ODI)of patients with low back and leg pain before the operation,1 day after the operation and 6 months after the operation were compared between the two groups.The modified Macnab method was used to evaluate the efficacy 6 months after the operation.Results No significant difference was found in baseline data between the two groups(all P values>0.05).In the UBE group,the operation time,intraoperative bleeding,and hospital stay were(70.7±8.8)min,(11.5±2.9)mL,and(4.9±1.2)days,respectively.Meanwhile,in the PETD group,the operation time,intraoperative bleeding,and hospital stay were(66.3±11.9)min,(13.0±3.5)ml,and(5.0±1.3)days,respectively.No significant difference was observed(t=1.72,-1.88,-0.32,all P values>0.05).The number of times of intraoperative fluoroscopy in the UBE group 8.6±2.2 was less than that in the PETD group 15.9±4.2,with a statistically significant difference(t=-8.73,P<0.001).No residual nucleus pulposus was observed in the UBE group.In the PETD group,there were two patient

关 键 词：椎间盘移位 腰椎 单侧双通道内镜技术 椎间孔镜 高度游离型 

分 类 号：R687.3[医药卫生—骨科学]