UBE术式与常规开放手术治疗腰椎间盘突出症的临床和放射学结果分析  

Analysis of Clinical and Radiological Outcomes between UBE Procedure and Conventional Open Surgery in the Treatment of Lumbar Disc Herniation

作　　者：丁恒 胡乐 李由 崔亮 张帆[1] 李兴国[1] DING Heng;HU Le;LI You;CUI Liang;ZHANG Fan;LI Xingguo(Dept.of Orthopedics,The 1st Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650032,China)

机构地区：[1]昆明医科大学第一附属医院骨科,云南昆明650032

出　　处：《昆明医科大学学报》2024年第9期62-69,共8页Journal of Kunming Medical University

基　　金：云南省科技厅-昆明医科大学应用基础研究联合专项基金资助项目(202101AY070001-120);云南省骨科与运动医学康复临床医学研究中心项目(202102AA310068)。

摘　　要：目的对比单边双通道脊柱内镜(unilateral biportal endoscopy,UBE)与传统开放手术治疗腰椎间盘突出症的临床疗效及影像学结果。方法回顾分析2022年1月至2023年3月在昆明医科大学第一附属医院收治的84例单节段腰椎间盘突出患者,其中44例接受单边双通道脊柱内镜手术(UBE组),40例接受传统开放手术。记录患者的年龄、性别、椎间盘突出部位、手术节段、手术时间、术中出血量、住院天数等信息。术前、术后2d和术后1月进行视觉模拟量表(VAS)评分及术后1月采用改良的Macnab评价指标评估疗效。比较2组术前和术后关节突保留率以及椎间盘高度变化。结果2组患者在年龄、性别、手术节段及椎间盘突出类型上的差异无统计学意义(P>0.05)。所有患者均顺利完成手术,相对于开放组,UBE组手术耗时较短,出血量更少,术后住院时间缩短(P<0.05),同时UBE组围术期并发症发生率显著低于开放组(P<0.05)。2组患者术前、术后2d时VAS评分明显下降(P<0.05),但术后1月时2组差异无统计学意义(P>0.05);且组内术前、术后2d及术后1月时VAS评分差异有统计学意义(P<0.05)。末次随访患者时改良Macnab疗效评定标准结果中UBE组优、良、可、差依次为40、2、2与0例,总体优良率高达95.4%。在开放手术组中,优良可差分别为29、7、4与0例,整体优良率达到90%。术前和术后2组患者的椎间盘高度进行比较,差异有统计学意义(P<0.05)。在UBE组中,术前和术后椎间盘高度之间比较,差异无统计学意义(P>0.05),而开放组术后椎间盘高度明显增加(P<0.05)。UBE组的关节突保留率为63.6%,而开放手术组的关节突保留率仅为10%。结论UBE可以直达靶点解除神经压迫,是一种微创、灵活、创伤小、学习曲线平缓、对脊柱活动度影响小、有利于术后康复的新技术,可彻底摘除突出髓核,临床治疗效果理想。Objective To compare the clinical efficacy and imaging results of unilateral biportal endoscopic discectomy(UBE)with traditional open surgery for the treatment of lumbar disc herniation.Methods We retrospectively analyzed 84 patients with single-segment lumbar disc herniation admitted to the First Affiliated Hospital of Kunming Medical University from January 2022 to March 2023,44 cases in the UBE group and 40 cases in the open surgery group,and recorded the patients'age,gender,disc herniation site,operation segment,operation time,intraoperative bleeding,and hospitalization days,respectively.Visual analog scale(VAS)scores were performed preoperatively,2 days postoperatively,and at follow-up at 1 month postoperatively.Efficacy was evaluated using the modified Macnab Treatment Effectiveness Evaluation Index at 1 month of surgery.The preoperative and postoperative articular process preservation rate and disc height changes were compared between the two groups.Results There were no statistically significant differences between the two groups of patients in terms of age,gender,operative segment and type of disc herniation(P>0.05).All patients completed the surgery.Compared with the open group,the UBE group had a shorter operation time,less bleeding,and a shorter postoperative hospitalization(P<0.05),and the perioperative complication rate was lower in the UBE group than in the open group(P<0.05).The VAS scores of patients in the two groups decreased significantly at preoperation and 2 days postoperation(P<0.05),but the difference between the two groups was not significant at 1 month postoperation(P>0.05);and the difference in VAS scores at preoperation,2 days postoperation and 1 month postoperation within the groups was statistically significant(P<0.05).The results of the modified Macnab efficacy evaluation criteria in the UBE group were 40,2,2 and 0 cases in order of excellent,good,acceptable and poor at the last follow-up,and the overall excellent rate was as high as 95.4%.In the open surgery group,there were 29,7,4

关 键 词：单边双通道脊柱内镜 传统开放手术 腰椎间盘突出症 疗效评定 

分 类 号：R681.57[医药卫生—骨科学]