形双通道脊柱内镜技术(VBE)用于LDH伴腰椎不稳患者的临床研究  

Clinical Efficacy of V-Shaped Double-channel Spinal Endoscopic Technique(VBE)in Patients with LDH and Lumbar Instability

作　　者：胡廷欢 王志华[2] 赵双林 刘富睿 陈丽琼 袁义文 陈方经 樊云山 杨建义 HU Tinghuan;WANG Zhihua;ZHAO Shuanglin;LIU Furui;CHEN Liqiong;YUAN Yiwen;CHEN Fangjing;FAN Yunshan;YANG Jianyi(Dept.of Orthopedics,Guandu District People’s Hospital of Kunming,Kunming Yunnan 650211;Dept.of Orthopedics and Trauma,The 1st Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650032;Dept.of Orthopedics,Wenshan People’s Hospital,Wenshan Yunnan 663000;Dept.of Pediatrics,Kunming Guandu District People’s Hospital,Kunming Yunnan 650211;Dept.of Spinal Surgery,Shanghai 10th People’s Hospital,Shanghai 200072;Dept.of Spinal Surgery,The 10th People’s Hospital Affiliated to Tongji University,Shanghai 200072,China)

机构地区：[1]昆明市官渡区人民医院骨科,云南昆明650211 [2]昆明医科大学第一附属医院创伤骨科,云南昆明650032 [3]文山市人民医院骨科,云南文山663000 [4]昆明市官渡区人民医院儿科,云南昆明650211 [5]上海市第十人民医院脊柱外科,上海200072 [6]同济大学附属第十人民医院脊柱外科,上海200072

出　　处：《昆明医科大学学报》2024年第8期93-100,共8页Journal of Kunming Medical University

基　　金：云南省贺石生专家工作站2021-2024年建设任务基金资助项目(202205AF150058)。

摘　　要：目的以常规经椎间孔椎间融合术(TLIF)为对照,分析V形双通道脊柱内镜技术(VBE)治疗腰椎间盘突出症(LDH)伴腰椎不稳的效果。方法选取2021年1月至2023年3月昆明市官渡区人民医院和上海市第十人民医院收治的102例LDH伴腰椎不稳患者,以随机分组软件分为TLIF组(予以TLIF术,n=51)、VBE组(予以VBE手术,n=51)。比较2组手术一般情况、围手术期疼痛程度(VAS评分)、手术前后腰痛与下肢痛程度(VAS评分)、腰椎稳定性(椎间隙高度、腰椎前凸角)、减压效果(硬膜囊横断面积、椎间孔面积)、功能预后及并发症情况。结果VBE组术中出血量少于TLIF组,切口长度、卧床时间、住院时间短于TLIF组(P<0.05);VBE组术后6 h、术后12 h、术后24 h、术后48 h、术后72 h的VAS评分低于TLIF组(P<0.05);术后3、6个月腰痛、下肢痛VAS评分及术后6个月椎间隙高度、腰椎前凸角、硬膜囊横断面积、椎间孔面积高于术前,但组间比较差异无统计学意义(P>0.05);2组功能预后优良率(98.04%、94.12%)比较,差异无统计学意义(P>0.05);VBE组无并发症发生,TLIF组1例出现切口渗出。结论VBE与TLIF治疗LDH伴腰椎不稳患者,可增强腰椎稳定性,改善患者腰椎功能,确保安全性,而VBE切口小,可减少术中出血,降低术后早期疼痛,加快早期病情恢复。Objective To compare the effectiveness of V-shaped double-channel spine endoscope technology(VBE)in treating lumbar disc herniation(LDH)with lumbar instability with traditional transforaminal lumbar interbody fusion(TLIF).Methods From January 2021 to March 2023,102 patients with LDH and lumbar instability admitted to the People's Hospital of Guandu District,Kunming City,and the Tenth People's Hospital of Shanghai were selected.They were randomly divided into two groups using random grouping software:the TLIF group(undergoing TLIF surgery,n=51)and the VBE group(undergoing VBE surgery,n=51).The two groups were compared in terms of general surgical conditions,perioperative pain levels(VAS scores),pre-and postoperative levels of back and leg pain(VAS scores),lumbar spine stability(intervertebral height,lumbar lordosis angle),decompression effect(cross-sectional area of the dural sac,intervertebral foramina area),functional prognosis,and complication status.Results In the VBE group,the amount of bleeding during the surgery was less than in the TLIF group,with shorter incision length,bed rest time,and hospital stay compared to the TLIF group(P<0.05).VAS scores at 6 hours,12 hours,24 hours,48 hours,and 72 hours post-operation were lower in the VBE group compared to the TLIF group(P<0.05).VAS scores for lower back pain and leg pain at 3 and 6 months post-operation,as well as intervertebral height,lumbar lordosis angle,dural sac cross-sectional area,and intervertebral foramen area at 6 months post-operation were higher than pre-operation levels in both groups,but the inter-group differences were not statistically significant(P>0.05).Comparison of the excellent-to-good functional prognosis rates between the two groups(98.04%,94.12%)showed no statistically significant difference(P>0.05).no complications occurred in the VBE group,while one case of incision exudation occurred in the TLIF group.Conclusion VBE and TLIF treatment for LDH with lumbar instability patients can enhance lumbar stability,improve patients'lumbar functi

关 键 词：腰椎间盘突出症 腰椎不稳 V形双通道脊柱内镜技术 经椎间孔椎间融合术 腰椎稳定性 疼痛程度 减压效果 预后 

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