经皮椎间孔镜与单侧双通道内镜治疗巨大型腰椎间盘突出症的疗效分析  

The analysis of the therapeutic efficacy of percutaneous endoscopic lumbar discectomy and unilateral biportal endoscopy in the treatment of giant lumbar disc herniation

作　　者：戴鑫威 邵嘉瑜 张先鹏 何泽伟 楼钰晗 杜文喜[3] Dai Xinwei

机构地区：[1]浙江中医药大学第一临床医学院,310053 [2]浙江中医药大学,310053 [3]浙江中医药大学附属第一医院(浙江省中医院),310003

出　　处：《浙江临床医学》2023年第10期1431-1434,共4页Zhejiang Clinical Medical Journal

基　　金：国家自然科学基金资助项目(81973873)。

摘　　要：目的评价经皮椎间孔镜(PELD)与经椎板间入路单侧双通道内镜(UBE)技术治疗巨大型腰椎间盘突出症(HLDL)的疗效并针对巨大游离型腰椎间盘突出症进行改良游离髓核分型探讨其分型方法的参考价值。方法回顾性分析2020年10月至2021年6月收治且符合纳入标准的巨大型腰椎间盘突出患者24例,UBE组16例、PELD组8例。两组患者的性别、年龄、病程、疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、既往腰椎手术史、双下肢症状等一般资料比较均无统计学意义(P>0.05)。记录并比较两组患者的围手术期指标和疗效指标;回顾分析两组患者的影像资料并依据改良游离髓核分型方法对其分型。结果两组患者均顺利完成手术,总手术时间无明显差异(P>0.05),术后住院时间无明显差异(P>0.05)。两组患者均获得随访,随访时间12~22个月,平均随访时间13.45个月。PELD组术后并发股神经损伤1例,1个月后完全恢复,UBE组术后第22个月复发1例,其余患者未出现手术相关并发症,术后恢复良好,两组术后并发症差异无统计学意义(P>0.05)。两组术后疼痛VAS评分及ODI较术前均明显改善(P<0.05),术后各个时间点VAS评分及ODI差异无统计学意义(P>0.05);UBE组巨大游离型腰椎间盘突出患者11例,其中B2型10例,A2型1例;PELD组巨大游离型腰椎间盘突出患者4例,B2组4例。结论PELD技术与UBE技术治疗巨大型腰椎间盘突出症的临床疗效相似,二者术后恢复情况并无明显差异;验证了改良游离髓核分型系统具有一定的可重复性。Objective To evaluate the clinical efficacy of percutaneous endoscopic lumbar discectomy(PELD)and unilateral biportal endoscopy(UBE)in the treatment of giant lumbar disc herniation(HLDL)and to explore the reference value of the classification method for the modified free nucleus pulposus classification of giant free lumbar disc herniation.Methods Twenty-four patients with giant lumbar disc herniation who were admitted from October 2020 to June 2021 and met the inclusion criteria were retrospectively analyzed,including 16 patients in the UBE group and 8 patients in the PELD group.The general data of gender,age,disease duration,pain visual analog score(VAS),Oswestry dysfunction index(ODI),history of previous lumbar spine surgery,and symptoms of both lower extremities were compared between the two groups,and the differences were not statistically significant(P>0.05).Perioperative indicators and clinical outcome indicators were recorded and compared between the two groups,the imaging data of the two groups were retrospectively analyzed and classified according to the improved free nucleus pulposus classification method.Results Patients in both groups completed the surgery successfully,with no significant difference in total operative time(P>0.05)and no significant difference in postoperative hospital stay(P>0.05).Patients in both groups were followed up for 12~22 months,with a mean follow-up time of 13.45 months.1 case of postoperative complication of femoral nerve damage in the PELD group and 1 case of recurrence in the 22nd month after surgery in the UBE group,the rest of patients did not have surgeryrelated complications and recovered well after surgery,and the difference in postoperative complications between the two groups was not statistically significant(P>0.05).Postoperative pain VAS scores and ODI were significantly improved in both groups compared with those before surgery(P<0.05),and VAS scores and ODI were not statistically significant at each postoperative time point(P>0.05).There were 11 patients with g

关 键 词：巨大型腰椎间盘突出 单侧双通道内镜 经皮椎间孔镜 临床疗效 

分 类 号：R687.3[医药卫生—骨科学]