经椎板间入路单通道内镜与单侧双通道内镜治疗腰椎间盘突出症的临床比较  

Clinical efficacy of uniportal interlaminar endoscopy versus unilateral biportal endoscopy for the treatment of lumbar disc herniation

作　　者：韩国嵩 马力[1] 祁家龙 郑科[1] 董洲 程永红[1] 张之栋[1] HAN Guosong;MA Li;QI Jialong;ZHENG Ke;DONG Zhou;CHENG Yonghong;ZHANG Zhidong(Department of Spine Surgery,the Third Affiliated Hospital of Anhui Medical University(Hefei First People's Hospital),Hefei 230061,China)

机构地区：[1]合肥市第一人民医院脊柱外科,合肥230061

出　　处：《实用医学杂志》2024年第11期1542-1548,共7页The Journal of Practical Medicine

基　　金：安徽医科大学第三附属医院基础与临床合作研究提升计划培育专项资助项目(编号:2023sfy015);合肥市中医药研究项目(编号:HFSZYYYJ2024-12)。

摘　　要：目的比较经椎板间入路单通道内镜(uniportal interlaminar endoscopy,UIE)与单侧双通道内镜(unilateral biportal endoscopy,UBE)治疗腰椎间盘突出症的临床疗效和影像学结果。方法收集2021年3月至2022年10月在合肥市第一人民医院采用UIE和UBE手术治疗的50例腰椎间盘突出症患者资料,其中UIE组28例,UBE组22例。分析比较两组患者术中指标(手术时间、切口长度、术中出血量、手术并发症)、不同时间点临床疗效指标(术前、术后3 d、3个月、6个月、1年)腰痛及腿痛视觉模拟评分(VAS评分)及功能障碍指数ODI、影像学结果(术前、术后1年椎间盘高度、硬膜囊面积及腰椎前凸角度)。结果两组患者手术后都进行了随访,随访时间为12~18个月,平均约为15个月。UIE组和UBE中各发生1例发生硬脊膜损伤,无神经根损伤,术后随访无神经根症状,腰腿痛症状也得到缓解。在围手术期指标和临床指标的比较中发现:UIE组在手术切口长度、术中出血量和手术时间方面均显著小于UBE组,差异具有统计学意义(P<0.05)。术后3 d、3个月、6个月和1年,UIE组和UBE组患者的腰腿痛VAS评分和ODI较术前均明显改善,差异具有统计学意义(P<0.05)。此外,UIE组在术后3 d和术后3个月的腰痛评分明显优于UBE组,差异具有统计学意义(P<0.05)。影像学结果:与术前相比,术后1年随访时,UIE组与UBE组椎间盘高度和腰椎前凸角度变化无差异;UIE组与UBE组术后硬膜囊面积均呈现显著增加,UIE组的术后硬膜囊面积小于UBE组(P<0.05)。结论经椎板间入路UIE与UBE治疗腰椎间盘突出症的均具有良好的临床疗效和影像学结果,UIE在手术切口、手术时间、术中出血量、短期内腰痛比较上更有优势,但UBE组减压更充分。Objective To compare the clinical efficacy and imaging results of uniportal interlaminar endoscopy(UIE)and unilateral biportal endoscopy(UBE)for the treatment of lumbar disc herniation.Methods The clinical information for 50 patients diagnosed with lumbar disc herniation was collected,and treated by UIE endoscopic surgery and UBE endoscopic surgery in the The First People's Hospital of Hefei city from March 2021 to October 2022 were retrospectively analyzed.The patients were divided into two groups,UIE group and the UBE group.Perioperative indexes including incision length,operation time,intraoperative blood loss,and surgical complications,clinical efficacy indexes including VAS scores of low back pain and leg pain before surgery,3 days after surgery,3 months after surgery,6 months after surgery,and 12 months after surgery,ODI scores of dysfunction index,and imaging results including spinal canal area,vertebral space height,before surgery and 1 year after surgery were recorded and compared between the two groups.Results Both groups completed the procedure and were followed up for 12~18 months,with an average of 15 months.1 case was dural injury,no nerve root injury,and no nerve root symptoms during the follow-up.The symptoms of lumbar and leg pain were all relieved in both groups after the procedure.The UBE groups hawed larger surgical incisions,more intraoperative blood loss,and shorter operative time compared to the UIE group(P<0.05,respectively).Both groups had significant developments in the VAS scores,ODI scores of back,and leg pain at 3 days,3 months,6 months,and 12 months after the operation(all P<0.05).The UIE group showed significant developments in the VAS scores and ODI scores of back and leg pain at 3 days and 3 months after the operation,as compared to the UBE group(P<0.05).The imaging analysis did not showed significant changes in the height of intervertebral space and the angle of lumbar lordosis,but a significantly larger increase in the dural sac area in both groups one year after the procedure,a

关 键 词：腰椎间盘突出症 单通道内镜 单侧双通道内镜 

分 类 号：R681.5[医药卫生—骨科学]