单侧双通道内镜下髓核摘除联合纤维环缝合治疗腰椎间盘突出症的疗效分析  

Effectiveness of unilateral biportal endoscopic discectomy and annulus fibrosus suture in the treatment of lumbar disc herniation

作　　者：梁龙博 朱宇[1] 李毅[1] 卢文龙 樊晓韩 李高磊 黎少言 张跃[1] 魏嘉良 凌华光 Liang Longbo;Zhu Yu;Li Yi;Lu Wenong;Fan Xiaohan;Li Gaoei;Li Shaoyan;Zhang Yue;WeiJiaiang;Ling Huaguang(Department of Orthopedics,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第二附属医院骨科二病区,郑州450000

出　　处：《中华实验外科杂志》2023年第5期978-980,共3页Chinese Journal of Experimental Surgery

摘　　要：目的比较单侧双通道内镜下腰椎间盘髓核摘除联合纤维环缝合与仅行髓核摘除手术治疗腰椎间盘突出症的临床疗效。方法分析郑州大学第二附属医院骨科自2019年10月至2021年11月行单侧双通道内镜下髓核摘除术手术治疗的59例单节段腰椎间盘突出症患者,依据术中是否缝合纤维环破口分为两组,27例行内镜下髓核摘除术后联合纤维环缝合治疗为观察组;32例仅行内镜下髓核摘除术为对照组。观察组男15例,女12例;年龄27~49岁,平均年龄38岁。对照组男18例,女14例;年龄29~51岁,平均40岁。比较两组术前、术后3 d、术后3、6、12个月疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)评价患者腰腿疼情况和腰椎功能状态、末次随访改良MacNab评分标准和复发情况等相关手术指标并进行统计分析。结果两组患者均顺利完成手术且无并发症。两组患者术前、术后3 d、3个月、6个月、12个月腰腿痛VAS评分(F=0.196,P>0.05)、ODI评分(F=0.676,P>0.05)组间比较,差异无统计学意义,两组术后各时间点腰腿痛VAS评分(F=364.690,P<0.001)及ODI评分(F=2102.959,P<0.001)均较术前明显改善,差异有统计学意义。末次随访时,观察组患者手术优良率高于对照组,差异无统计学意义(88.89%比84.38%,χ^(2)=0.015,P>0.05)。两组患者术后复发情况对比结果显示,观察组的复发率低于对照组,差异有统计学意义(P<0.05)。结论单侧双通道内镜下行髓核摘除联合纤维环缝合修复治疗腰椎间盘突出症,安全有效,能重建纤维环的完整性,降低术后复发率。Objective To compare the clinical effects of unilateral biportal endoscopic discectomy(UBED)combined with annulus fibrosus suture and simple lumbar discectomy in the treatment of lumbar disc herniation(LDH).Methods The clinical data of 59 patients with single segment LDH treated with UBED and annulus fibrosus suture in our hospital between October 2019 and November 2021 were retro-spectively analyzed.The patients were divided into two groups according to whether the annulus fibrosus was sutured.The observation group included 27 patients who were treated with suture of annulus fibrosus defect,and the control group included 32 patients who were treated without suture of annulus fibrosus de-fect.In the observation group,there were 15 males and 12 females with an average age of 38 years(range,27-49 years).The control group included 18 males and 14 females with an average age of 40 years(range,29-51 years).Visual analogue scale(VAS)was used to assess the low back and leg pain and Oswestry disability index(ODI)was used to evaluate the function recovery of lumbar spine before and 3 days,3 months,6 months and 12 months after operation.MacNab criteria at the last follow-up and recurrence were statistically analyzed.Results Both groups completed treatment without complications.The VAS scores of low back pain and leg pain and ODI at each time point had no statistically significant difference between the two groups(F=0.196,0.676,P>0.05).Postoperative VAS scores and ODI scores at each time point in both groups were obviously improved as compared with those before operation(F=364.690,2102.959,P<0.05).At the last follow-up,Macnab score of the observation group was higher than that of control group(88.89%vs.84.38%,χ^(2)=0.015,P>0.05).The recurrence rate in observation group was lower than the control group with difference being statistically significant(P<0.05).Conclusion Unilateral biportal endoscopic discectomy combined with annulus fibrosus suture is a safe and effective method for the treat-ment of LDH,which can reconstruct

关 键 词：腰椎间盘突出症 腰椎髓核摘除 纤维环缝合 

分 类 号：R687.3[医药卫生—骨科学]