经皮单侧双通道微创内镜下椎间盘切除术治疗腰椎间盘突出症的效果  

Effect of percutaneous unilateral biportal endoscopic discectomy in treating lumbar disc herniation

作　　者：韩鹏远 尚琦松 吴兵 盛文辉 王晓楠 张伟亚 何方生 HAN Pengyuan;SHANG Qisong;WU Bing;SHENG Wenhui;WANG Xiaonan;ZHANG Weiya;HE Fangsheng(Department of Orthopedics,Shihezi General Hospital of The Eighth Division,Shihezi 832000,Xinjiang,China)

机构地区：[1]第八师石河子市总医院骨一科,新疆石河子832000

出　　处：《西部医学》2024年第12期1823-1828,共6页Medical Journal of West China

基　　金：兵团科技计划项目(2022CB010-04);八师石河子市财政科技计划项目(2022NY05)。

摘　　要：目的探讨经皮单侧双通道微创内镜下椎间盘切除术(UBED)治疗腰椎间盘突出症(LDH)的效果及对临床症状改善、腰椎功能的影响。方法回顾性选取2021年1月—2022年1月我院收治的127例LDH患者,根据其使用的手术方式分为开窗组(59例)和UBED组(68例)。开窗组使用椎板开窗椎间盘切除术,UBED组使用UBED手术方式。比较两组患者手术前后临床症状、腰椎功能、炎症因子水平及临床疗效。结果开窗组手术时间短于UBED组,平均C臂透视次数多于UBED组,差异均有统计学意义(P<0.05);开窗组术中出血量大于UBED组,差异无统计学意义(P>0.05)。UBED组患者术后腰痛、下肢痛视觉模拟(VAS)评分及改良Oswestry功能障碍指数(ODI)指数明显低于开窗组(P<0.05),而日本骨科协会(JOA)量表评分显著高于开窗组(P<0.05);UBED组术后3 d的IL-1β、TNF-α、基质金属蛋白酶(MMP-3)水平明显低于开窗组(P<0.05);UBED组优良率高于开窗组,但差异无统计学意义(P>0.05)。两组患者手术并发症比较,差异无统计学意义(P>0.05)。结论经皮UBED可有效改善LDH患者临床症状,促进腰椎功能恢复,降低炎症因子水平,疗效显著。Objective To investigate the effect of percutaneous unilateral biportal endoscopic discectomy(UBED)in treating lumbar disc herniation(LDH)and the influence on clinical symptoms and lumbar function.Methods A total of 127 patients with LDH who were admitted to the hospital from January 2021 to January 2022 were reviewed.Among them,patients treated with fenestration discectomy and those treated with UBED were defined as the fenestration group(59 cases)and the UBED group(68 cases).Clinical symptoms,lumbar function,inflammatory factor levels and clinical effects were compared between groups.Results The operation time in the fenestration group was shorter than that in the UBED group,and the average C-arm fluoroscopy frequency was higher than that in the UBED group(P<0.05).Intraoperative blood loss of the fenestration group was more than that of the UBED group,but the difference was not statistically significant(P>0.05).The Visual Analogue Scale(VAS)scores for postoperative low back pain and lower limb pain and modified Oswestry Disability Index(ODI)scores in the UBED group were significantly lower than those in the fenestration group(P<0.05).The Japanese Orthopaedic Association(JOA)scores were significantly higher than those in the fenestration group(P<0.05).The levels of interleukin(IL-1β),tumor necrosis factor(TNF-α)and matrix metalloproteinase 3(MMP-3)in the UBED group on day 3 after operation were significantly lower than those in the fenestration group(P<0.05).The excellent and good rate of clinical efficacy in the UBED group was higher than that in the fenestration group,but there was no statistical significance(P>0.05).There was no statistically significant difference in surgical complications between the two groups(P>005).Conclusion Percutaneous UBED can effectively improve clinical symptoms of patients with LDH,promote the recovery of lumbar function,and lower the levels of inflammatory factors.

关 键 词：经皮单侧双通道微创内镜下椎间盘切除术 腰椎间盘突出症 效果 临床症状 腰椎功能 

分 类 号：R681.5[医药卫生—骨科学]