单侧双通道内镜下椎间盘切除术与经皮内镜椎间孔入路椎间盘切除术治疗钙化型腰椎间盘突出症的对比研究  

A comparative study of unilateral biportal endoscopic discectomy versus percutaneous endoscopic transforaminal discectomy for trea tment of calcified lumbar disc herniation

作　　者：李稳超 李红卫[1] 朱广晔 周宇 郭宏 李亚浩 姜宏[1] 俞鹏飞[1] LI Wenchao;LI Hongwei;ZHU Guangye;ZHOU Yu;GUHong;LI Yahao;JIANG Hong;YU Pengfei(Suzhou Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine,Suzhou 215009,Jiangsu,China)

机构地区：[1]南京中医药大学附属苏州市中医医院,江苏苏州215009

出　　处：《中医正骨》2023年第10期1-6,共6页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：国家自然科学基金项目(82004393);苏州市科技发展计划项目(SKY2023066,SYSD2020146);苏州市姑苏卫生人才计划人才科研项目(GSWS2021049)。

摘　　要：目的:比较单侧双通道内镜(unilateral biportal endoscopy,UBE)下椎间盘切除术与经皮内镜椎间孔入路椎间盘切除术(percutaneous endoscopic transforaminal discectomy,PETD)治疗钙化型腰椎间盘突出症的疗效和安全性。方法:收集2020年1月至2022年1月收治的60例钙化型腰椎间盘突出症患者的病例资料,其中30例采用UBE下椎间盘切除术治疗(UBE组)、30例采用PETD治疗(PETD组)。比较2组患者的手术时间、术中X线透视次数、隐性失血量、住院时间、末次随访时腰痛视觉模拟量表(visual analogue scale,VAS)评分、末次随访时腿痛VAS评分、末次随访时Oswestry功能障碍指数(Oswestry disability index,ODI)、基于改良MacNab标准评定的综合疗效及并发症发生情况。结果:2组患者隐性失血量、住院时间、末次随访时腰痛VAS评分、末次随访时腿痛VAS评分的组间差异均无统计学意义[隐性失血量:(398.23±155.41)mL,(374.26±155.41)mL,t=-0.642,P=0.523;住院时间:(6.00,2.50)d,(6.00,2.00)d,Z=-0.323,P=0.747;末次随访时腰痛VAS评分:(1.00,1.00)分,(1.00,1.00)分,Z=-0.248,P=0.804;末次随访时腿痛VAS评分:(2.00,1.00)分,(2.00,0.00)分,Z=-0.907,P=0.364];与PETD组相比,UBE组的手术时间更短、术中X线透视次数更少、末次随访时ODI更低[手术时间:(66.67±7.34)min,(70.77±5.31)min,t=-2.480,P=0.016;术中X线透视次数:(4.00,0.00)次,(9.00,2.25)次,Z=-6.802,P=0.000;末次随访时ODI:(11.00,3.25)%,(13.25,2.00)%,Z=-4.570,P=0.000]。2组综合疗效的差异无统计学意义(Z=-0.108,P=0.914)。UBE组1例术中发生硬脊膜撕裂、2例术后下肢皮肤感觉障碍加重、2例发生切口疝,PETD组1例术中发生硬脊膜撕裂、3例术后下肢皮肤感觉障碍加重,经对症处理后均顺利出院,2组患者并发症发生率的差异无统计学意义(P=1.000)。结论:应用UBE下椎间盘切除术与PETD治疗钙化型腰椎间盘突出症的疗效和安全性相当,但UBE技术在减少术中X线透视次数、缩短手�Objective:To compare the clinical outcomes and safety of unilateral biportal endosopie(UBE)discctomay versus percuta-neous endoscopic transforminal discctomy(PETD)in treatment of caleified lumbar dise hermiation(CLDH).Methods:The dlinical data of 60 patients with CLDH recruited from January 2020 to January 2022 were ollcted.Thrnty patients were treated with UBE discectomy(UBE group)and 30 ones with PETD(PETD group).The operative time,intraoperative X-ray exposure,hidden blood loss,hospital stays,total out-comes evaluated according to the modified Macneb's criterion,and the complications were compared between the 2 groups;besides,the low back pain visual analogue scale(VAS)score,the leg pain VAS score and the Oswestry disbility index(0DI)evaluated at the last fllowup were compared between the 2 groups.Results:The dfference was not satistically significant in the hidden blood loss,hospital stays,the low back and leg pain VAS scores evaluated at the last fllow-up between the 2 groups(hidden blood loss:398.23±155.41 vs 374.26±155.41 mL,t=-0.642,P=0.523;hospital stays:(6.00,2.50)vs(6.00,2.00)days,Z=-0.323,P=0.747;low back pain VAS score evaluated at the last fllowup:(1.00,1.00)vs(1.00,1.00)points,Z=-0.248,P=0.804;leg pain VAS score evaluated at the last follow-up:(2.00,1.00)v<(2.00,0.00)points,Z=-0.907,P=0.364).The UBE group displayed shorter operative time,fewer intraoperative X-ray exposure and lower ODI evaluated at the last fllow-up compared to PETD group(operative time:66.67±7.34 vs 70.77±5.31 minutes,t=-2.480,P=0.016;intraoperative X-ray exposure:(4.00,0.00)v(9.00,2.25)times,Z=-6.802,P=0.000;0DI evaluated at the last follow-up:(11.00,3.25)(13.25,2.00)%,Z=-4.570,P=0.000).There was no statistical difference in the total outcomes between the2 groups(Z=-0.108,P=0.914).The intraoperative dural tears(1 case),postoperative aggravated ecsthesiodermia in lower extremity(2 cases),and incisional hermia(2 cases)were found in UBE group;while the intraoperative dural tears(1 case),and postoperative aggravated esthesioderm

关 键 词：椎间盘移位 腰椎 椎间盘切除术 内窥镜 临床试验 

分 类 号：R687.3[医药卫生—骨科学]