单侧双通道脊柱内镜与经皮椎间孔镜治疗腰椎间盘突出症的学习期特征分析及疗效观察  

Application analysis and curative effect observation of unilateral double-channel spinal endoscope and percutaneous intervertebral foramen endoscope in treatment of lumbar disc herniation during learning period

作　　者：曹泽[1] 宋锦程[1] 王黎明[1] 陈国兆 赵理平[1] CAO Ze;SONG Jin-cheng;WANG Li-ming;CHEN Guo-zhao;ZHAO Li-ping(Department of Orthopedics,the First People’s Hospital of Zhangjiagang City,Suzhou,Jiangsu 215600,China)

机构地区：[1]张家港市第一人民医院骨科,江苏苏州215600

出　　处：《颈腰痛杂志》2023年第6期945-949,共5页The Journal of Cervicodynia and Lumbodynia

基　　金：江苏省卫生健康委科研项目(编号:Z2021086);张家港市科学技术局医疗卫生科技创新指导性项目(编号:ZKYL2241)。

摘　　要：目的分析单侧双通道脊柱内镜(unilateral biportal endoscopy,UBE)技术和经皮椎间孔镜椎间盘切除术(percutaneous endoscopic lumbar discectomy,PELD)治疗腰椎间盘突出症患者的学习期特征,并探究其临床疗效。方法选取2020年8~10月在本院由初学者开展UBE或PELD技术治疗的腰椎间盘突症患者67例临床资料进行回顾性分析。其中UBE组32例、PELD组35例。记录两组患者的手术操作时间、X线透视次数、术后住院时间并绘制学习曲线,分析两种术式的学习期特征。另外,比较两组切口长度,并采用视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)、改良MacNab评定标准比较其临床效果。结果随着患者例数增加,UBE组、PELD组的手术时间、X线透视次数均逐渐减少,住院时间保持稳定;UBE组的手术时间、X线透视次数的变化曲线较为平稳,而PELD组的变化曲线较为陡峭。PELD组的手术时间及术后住院天数少于UBE组,差异有统计学意义(P<0.05)。两组术后腰腿痛VAS评分、ODI指数均较术前明显改善(P<0.05),但相同时间点两组间的比较,差异无统计学意义(P>0.05)。术后3个月随访时,按照改良MacNab评定标准,两组患者的手术优良率对比,差异无统计学意义(P>0.05)。结论UBE和PELD治疗腰椎间盘突出症的短期临床疗效相当。UBE的适应证更广,而PELD手术耗时短,临床实践中可根据实际情况选择合适的手术路径。Objective To analyze the study period of patients with lumbar disc herniation(LDH)treated by unilateral dual-channel spinal endoscopy(UBE)and percutaneous endoscopic lumbar discectomy(PELD),and to explore their clinical effects.Methods The clinical data of 67 patients with LDH treated in our hospital from August 2020 to October 2022 were selected for retrospective analysis.The patients were divided into the UBE group(32 cases)and the PELD group(35 cases).The visual analogue scale(VAS),Oswestry disability index(ODI)and modified MacNab criteria were used to evaluate the clinical effects.Results With the increase of the number of patients,the operation time and X-ray times in UBE group and PELD group were significantly reduced(P<0.05),and the hospitalization time remained stable.The operation time and postoperative hospital stay in the PELD group were less than those in the UBE group,and the differences were statistically significant(P<0.05).The VAS score,ODI in the two groups were significantly improved compared with those before operation(P<0.05),but there was no significant difference between the two groups at corresponding time points(P>0.05).At the third month of follow-up,according to the modified MacNab criteria,the excellent and good rate in the two groups was similar,and the difference was not statistically significant(P>0.05).Conclusion The short-term clinical efficacy of UBE and PELD in the treatment of lumbar disc herniation is equivalent.The indication of UBE is wider,but the operation time of PELD is shorter,so the appropriate surgical path can be selected according to the actual situation in clinical practice.

关 键 词：单侧双通道脊柱内镜技术 经皮椎间孔镜椎间盘切除术 腰椎间盘突出症 学习期 临床疗效 

分 类 号：R687.3[医药卫生—骨科学] R681.5[医药卫生—外科学]