单侧双通道脊柱内镜技术治疗脱垂型腰椎间盘突出症的早期疗效  

Early effectiveness of unilateral biportal endoscopy technique for migrated lumbar intervertebral disc herniation

作　　者：黄吉军 王永祥 杨建东 冯新民 HUANG Jijun;WANG Yongxiang;YANG Jiandong;FENG Xinmin(Department of Spine Surgery,Northern Jiangsu People’s Hospital Affiliated to Yangzhou University,Yangzhou Jiangsu,225001,P.R.China)

机构地区：[1]扬州大学附属苏北人民医院脊柱外科,江苏扬州225001

出　　处：《中国修复重建外科杂志》2024年第11期1367-1371,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金资助项目(82072423)。

摘　　要：目的探讨单侧双通道脊柱内镜(unilateral biportal endoscopy,UBE)技术治疗脱垂型腰椎间盘突出症的早期疗效。方法回顾性分析2021年5月—2022年12月收治且符合选择标准的87例脱垂型腰椎间盘突出症患者临床资料,均采用UBE技术手术。男55例,女32例;年龄29~74岁,平均48.8岁。病程2~23个月,平均9.1个月。手术节段:L3、417例,L4、532例,L5、S138例。根据Lee等提出的MRI椎间盘脱垂分型:1型12例,2型17例,3型37例,4型21例。记录手术时间、住院时间以及手术并发症发生情况。术前及术后3 d、3个月、6个月、12个月,以疼痛视觉模拟评分(VAS)评估腰腿疼痛程度,Oswestry功能障碍指数(ODI)评估腰椎功能;末次随访时通过改良MacNab标准评估手术疗效优良率。按照术前椎间盘脱垂分型将患者分为Ⅰ~Ⅳ组,比较VAS评分及ODI差异。结果87例患者均顺利完成手术,术中无神经根、硬膜囊损伤及硬膜撕裂发生,手术时间(58.6±14.6)min,住院时间(4.0±0.8)d。术后切口均Ⅰ期愈合,均未发生症状性硬膜外血肿。患者均获随访12个月。术后各时间点VAS评分、ODI与术前比较,差异均有统计学意义(P<0.05);VAS评分仅术后3 d与3、6、12个月比较差异有统计学意义(P<0.05);ODI除术后6、12个月间差异无统计学意义(P>0.05)外,术后其余时间点间差异均有统计学意义(P<0.05)。末次随访时,根据改良MacNab标准评定手术疗效,获优66例、良13例、中8例,优良率为90.8%。随访期间均无复发。Ⅰ~Ⅳ组术前及术后各时间点VAS评分及ODI组间比较,差异均无统计学意义(P>0.05)。结论UBE技术治疗脱垂型腰椎间盘突出症创伤小、并发症发生率低,能获得满意早期疗效。Objective To explore early effectiveness of unilateral biportal endoscopy(UBE)technique in the treatment of migrated lumbar intervertebral disc herniation.Methods A retrospective analysis was conducted on 87 patients with migrated lumbar intervertebral disc herniation,who were treated with UBE technique between May 2021 and December 2022 and met the selection criteria.There were 55 males and 32 females,with an average age of 48.8 years(range,29-74 years).The disease duration ranged from 2 to 23 months,with an average of 9.1 months.The surgical segments included 17 cases of L3,4,32 cases of L4,5,and 38 cases of L5,S1.According to Lee’s classification criteria,there were 12 cases of type 1,17 cases of type 2,37 cases of type 3,and 21 cases of type 4.The operation time,length of hospital stay,and complications were recorded.The visual analogue scale(VAS)score was used to assess the degree of low back and leg pain before operaion and at 3 days,3 months,6 months,and 12 months after operation.The Oswestry disability index(ODI)was used to evaluate the lumbar spine function.At last follow-up,the modified MacNab criteria was used to evaluate the effectiveness.According to the preoperative migrated intervertebral disc classification,the patients were allocated into groupsⅠtoⅣ.The differences in VAS score and ODI were compared.Results All 87 patients successfully completed the operations.There was no nerve root injury,dural sac injury,or dural tear during operation.The operation time was(58.6±14.6)minutes and the length of hospital stay was(4.0±0.8)days.All incisions healed by first intention after operation.No symptomatic epidural hematoma occurred.All patients were followed up for 12 months.There were significant differences in VAS scores and ODI at each time point after operation when compared with those before operation(P<0.05).There were significant differences in VAS score at 3 days after operation when compared with that at 3,6,and 12 months after operation(P<0.05).For ODI,except that there was no significant

关 键 词：单侧双通道脊柱内镜技术 脱垂型腰椎间盘突出症 腰椎间盘切除术 微创手术 早期疗效 

分 类 号：R687.3[医药卫生—骨科学]