两种入路内镜椎间盘摘除术治疗腰椎间盘突出症的疗效比较  

Comparison effect of endoscopic discectomy with two kinds of approaches for lumbar disc herniation

作　　者：陈康 罗园超 杨富国 何仁建[1] CHEN Kang;LUO Yuan-chao;YANG Fu-guo;HE Ren-jian(Dept of Orthopaedics,Zigong First People′s Hospital,Zigong,Sichuan 643000,China)

机构地区：[1]自贡市第一人民医院骨科,四川自贡643000

出　　处：《临床骨科杂志》2024年第4期486-490,共5页Journal of Clinical Orthopaedics

基　　金：四川省自贡市科技局重点科技计划项目(编号:2021YLSF01);四川省医学会医学科研项目(编号:S20057)。

摘　　要：目的比较单侧双通道内镜(UBE)技术与椎板间入路经皮内镜腰椎间盘髓核摘除术(IL-PELD)治疗腰椎间盘突出症的临床疗效。方法将83例腰椎间盘突出症患者根据手术方式不同分为UBE技术组(采用UBE技术治疗,37例)和IL-PELD组(采用IL-PELD治疗,46例)。比较两组术中透视次数、术中出血量、手术时间、住院时间、硬膜囊破裂率和腰椎间盘突出复发率、腰痛及下肢痛VAS评分、ODI。采用改良MacNab标准评价临床疗效。结果患者均获得随访,时间13~33(21.8±5.9)个月。术中出血量、手术时间IL-PELD组少(短)于UBE技术组(P<0.05);术中透视次数、住院时间两组比较差异均无统计学意义(P>0.05)。术后3个月腰痛VAS评分UBE技术组高于IL-PELD组(P<0.01);其余各项观察及评价指标两组比较差异均无统计学意义(P>0.05)。结论UBE技术与IL-PELD治疗腰椎间盘突出症均可取得良好的早期临床疗效。IL-PELD微创,但显露有限,适用于单纯腰椎间盘突出症的治疗;UBE技术减压范围更广、减压更彻底,学习曲线平缓,适用于复杂腰椎间盘突出症的治疗。Objective To compare the clinical effects of unilateral biportal endoscopy(UBE)technique and interlaminar percutaneous endoscopic lumbar discectomy(IL-PELD)in the treatment of lumbar disc herniation.Methods The 83 patients with lumbar disc herniation were divided into UBE technique group(37 cases were treated with UBE technique)and IL-PELD group(46 cases were treated with IL-PELD),according to different surgical approaches.The intraoperative fluoroscopy frequency,intraoperative blood loss,operation time,hospital stay time,dural tear rate,recurrence rate of lumbar disc herniation,VAS of low back and lower limb pain,and ODI index were compared between the two groups.Clinical efficacy was evaluated with modified MacNab criteria at the last follow-up.Results All patients were followed up for 13~33(21.8±5.9)months.Intraoperative blood loss and operation time in IL-PELD group were less(shorter)than those in UBE technique group(P<0.05).There were no statistical differences in intraoperative fluoroscopy frequency and hospital day between the two groups(P>0.05).At 3 months after surgery,the VAS of lower back pain in the UBE technique group was higher than that in the IL-PELD group(P<0.01).There were no statistical differences in the other observation and evaluation indicators between the two groups(P>0.05).Conclusions Both UBE technique and IL-PELD can achieve good early clinical efficacy in the treatment of lumbar disc herniation.IL-PELD is minimally invasive,but with limited exposure,which is suitable for the treatment of simple lumbar disc herniation;UBE technique has a wider range of decompression,more thorough decompression,and a smooth learning curve,making it suitable for the treatment of complex lumbar disc herniation.

关 键 词：腰椎间盘突出 单侧双通道内镜技术 椎板间入路经皮内镜腰椎间盘髓核摘除术 并发症 

分 类 号：R681.57[医药卫生—骨科学] R687.3[医药卫生—外科学]