单侧双通道内窥镜技术与经皮内窥镜下腰椎椎间盘切除术治疗单节段腰椎椎间盘突出症的早期疗效比较  

Early efficacy of unilateral biportal endoscopic technique versus percutaneous endoscopic lumbar discectomy for treatment of single-segment lumbar disc herniation

作　　者：陈康 杨富国 罗园超 何仁建[1] Chen Kang;Yang Fuguo;Luo Yuanchao;He Renjian(Department of Orthopaedics,Zigong First People’s Hospital,Zigong 643000,Sichuan,China)

机构地区：[1]自贡市第一人民医院骨科,自贡643000

出　　处：《脊柱外科杂志》2023年第3期155-161,共7页Journal of Spinal Surgery

基　　金：四川省医学科研课题计划项目(S20057);自贡市科学技术局重点科技计划项目(2021YLSF01)。

摘　　要：目的对比单侧双通道内窥镜(UBE)技术与经皮内窥镜下腰椎椎间盘切除术(PELD)治疗单节段腰椎椎间盘突出症(LDH)的早期临床疗效。方法回顾性分析2020年10月—2021年4月接受手术治疗的77例单节段LDH患者临床资料,其中采用UBE技术治疗30例(UBE组),采用PELD治疗47例(PELD组)。记录2组手术时间、术中出血量、透视次数、住院时间及并发症发生情况。术前及术后1、3、6、12个月和末次随访时采用疼痛视觉模拟量表(VAS)评分评估腰腿痛程度,采用Oswestry功能障碍指数(ODI)评估腰椎功能。末次随访时采用改良MacNab标准评价临床疗效。结果所有手术顺利完成,患者随访>12个月。UBE组手术时间长于PELD组,术中出血量、透视次数少于PELD组,差异均有统计学意义(P<0.05)。2组患者术后腰腿痛VAS评分及ODI较术前显著改善,差异均有统计学意义(P<0.05)。UBE组术后1、3、6个月的腰痛VAS评分高于PELD组,差异均有统计学意义(P<0.05)。2组术后各随访时间点腿痛VAS评分、ODI组间差异无统计学意义(P>0.05)。末次随访时按照改良MacNab标准,UBE组疗效优良率为90.0%,PELD组为89.4%,差异无统计学意义(P>0.05)。UBE组发生术中硬膜撕裂2例,术后复发2例;PELD术后复发1例。结论UBE和PELD治疗单节段LDH均可获得良好的早期临床疗效,各有优势,UBE适应证更广泛,学习曲线平缓;PELD创伤更小,患者术后早期腰痛程度更轻。Objective To compare the early efficacy of unilateral biportal endosco(pyUBE)technique and percutaneous endoscopic lumbar discectomy(PELD)in the treatment of single-segment lumbar disc herniation(LDH).Methods From October 2020 to April 2021,the clinical data of 77 patients with singl-esegment LDH who received surgical treatment were retrospectively analyzed,including 30 treated with UBE techniqu(e UBE group)and 47 with PEL(D PELD group).The operation time,intraoperative blood loss,fluoroscopy frequency,hospital stay and complications were recorded in the 2 group s.The visual analog scal(e VAS)score and Oswestry disability inde(xODI)were used to evaluate the intensity of low bac k and leg pain and lumbar function at pre-operation,postoperative 1,3,6,12 months and the final follow-up.The modified MacNab criteria was used to evaluate the clinical efficacy at the final follow-up.Results All the operations were successfully completed,and the patients were followed up for more than 12 months.Thoep eration time in the UBE group was longer tha n that in the PELD group,the intraoperative blood loss and fluoroscopy frequency were lses than those in the EPLD group,all with a significant differenc(eP<0.05).The VAS scores of low back and leg pain and ODI of the 2 gprso uafter operation were significantly improved compared with those before operation,all with a significant differenc(eP<0.05).The VAS scores of low back pain in the UBE group at postoperative 1,3,6 months were higher than those in the PELD group,and the differences were statistically significan(t P<0.05).There was no significant difference in the VAS score of lega inp and ODI between the 2 groups at each follow-up time poin(t P>0.05).At the final follow-up,according to the modified MacNab criteria,the excellent and good rate of efficacy was 90.0%in the UBE group and 89.4i%n the PELD group,and there was no statistical significance between the 2 group(s P>0.05).In the UBE group,intraoperative dural tear occurred in 2 cases,postoperative recurrence in 1;in the PELD

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：R681.533[医药卫生—骨科学]