两种方法治疗腰椎间盘突出症的疗效比较  

Comparison of two types of methods for treatment of lumbar disc herniation

作　　者：张颉鸿 袁航 杨永竑 卢一生[1] 符楚迪[1] ZHANG Jie-hong;YUAN Hang;YANG Yong-hong;LU Yi-sheng;FU Chu-di(Dept of Orthopaedics,the 903rd Hospital of Joint Logistic Support Force of CPLA,the Spine Center of Whole Army,Hangzhou,Zhejiang 310004,China)

机构地区：[1]中国人民解放军联勤保障部队第903医院骨科,全军脊柱外科中心,浙江杭州310004

出　　处：《临床骨科杂志》2024年第4期491-495,共5页Journal of Clinical Orthopaedics

基　　金：浙江省卫健委医药卫生科技项目(编号:2022RC238);浙江省杭州市卫健局医药卫生科技项目(编号:B20200475、2017Z11)。

摘　　要：目的比较经皮内镜腰椎间盘切除术(PELD)与单侧双通道脊柱内镜下髓核摘除术(UBED)治疗腰椎间盘突出症的临床疗效。方法将60例单节段脱出型腰椎间盘突出症患者根据手术方法不同分为PELD组(采用PELD治疗,30例)与UBED组(采用UBED治疗,30例)。比较两组手术情况、疼痛VAS评分、ODI、JOA评分。采用改良MacNab标准评估临床疗效。结果患者均获得随访,时间24~32个月。术中透视次数、手术时间UBED组少(短)于PELD组(P<0.05),术后住院时间两组比较差异无统计学意义(P>0.05)。两组疼痛VAS评分、ODI、JOA评分术后各时间点均较术前明显改善(P<0.05)。疼痛VAS评分、ODI:术后1周UBED组均低于PELD组(P<0.05),术后3个月、1年、2年两组比较差异均无统计学意义(P>0.05)。JOA评分:术后3个月UBED组高于PELD组(P<0.05),术后1周、1年、2年两组比较差异均无统计学意义(P>0.05)。术后2年改良MacNab标准评价的临床疗效优良率两组比较差异无统计学意义(P>0.05)。结论相较于PELD,UBED治疗腰椎间盘突出症在手术操作便捷性和短期疗效上具有优势。Objective To compare the clinical efficacy of percutaneous endoscopic lumbar discectomy(PELD)and unilateral biportal endoscopic discectomy(UBED)in the treatment of lumbar disc herniation.Methods The 60 patients with single-level prolapsed lumbar disc herniation were divided into PELD group(PELD treatment,30 cases)and UBED group(UBED treatment,30 cases),according to different surgical methods.The surgical status,pain VAS,ODI,and JOA scores of the two groups were compared.The modified MacNab standard was used to evaluate the clinical efficacy.Results All patients were followed up for 24~32 months.The intraoperative fluoroscopy frequency and operation time were less(shorter)in UBED group than those in PELD group(P<0.05),and there was no statistical difference in postoperative hospital stay between the two groups(P>0.05).The pain VAS,ODI,JOA scores of both groups were significantly improved at all time points after surgery,compared with the preoperation(P<0.05).Pain VAS and ODI scores:1 week after surgery,UBED group were better than PELD group(P<0.05),and there were no statistical differences between the two groups at 3 months,1,2 years after surgery(P>0.05).The JOA scores:3 months after surgery,UBED group was better than PELD group(P<0.05),and there were no statistical differences between the two groups at 1 week,1 year and 2 years after surgery(P>0.05).Two years after surgery,the modified MacNab standard was used to evaluate the clinical effect,and there was no statistical difference in the excellent-good rate between the two groups(P>0.05).Conclusions Compared with traditional PELD,UBED has advantages in surgical convenience and short-term efficacy in the treatment of lumbar disc herniation.

关 键 词：经皮内镜腰椎间盘切除术 单侧双通道脊柱内镜下髓核摘除术 脱出型腰椎间盘突出症 

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