单侧双通道内镜技术与显微镜下髓核摘除术治疗老年腰椎间盘突出症的疗效比较  

Comparison of the effect between unilateral biportal endoscopic technique and microscopic lumbar discectomy in the treatment of lumbar disc herniation in the elderly

作　　者：王彦[1] 王雨 高俊[1] 杨建平[1] WANG Yan;WANG Yu;GAO Jun;YANG Jianping(Department of Orthopedics,Changzhou Hospital of Traditional Chinese Medicine,Changzhou 213000)

机构地区：[1]常州市中医医院骨科,常州213000

出　　处：《颈腰痛杂志》2025年第2期204-211,共8页The Journal of Cervicodynia and Lumbodynia

基　　金：江苏省重点研发计划专项资金项目(BE2019653)。

摘　　要：目的与显微镜下髓核摘除术(MSLD)相比较,探究单侧双通道内镜(UBE)技术治疗老年腰椎间盘突出症(LDH)的价值。方法选取2019年5月至2022年12月本院收治的80例老年LDH患者,依据所采取的手术方式不同分为UBE组(n=40,行UBE下髓核摘除术)、MSLD组[n=40,行显微镜下髓核摘除术(MSLD)],比较两组围术期相关指标(手术时间、住院时间),随访12个月,比较两组临床疗效、各随访时间点下肢与腰部的疼痛视觉模拟评分(VAS),炎症因子[C反应蛋白(CRP)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]、肌酸激酶(CK)及血红蛋白(Hb)水平、手术节段椎间隙高度、Oswestry功能障碍指数(ODI),记录两组并发症情况。结果UBE组与MSLD组比较,两组疗效优良率(92.50%vs 90.00%)、并发症发生率(2.50%vs 7.50%)差异无统计学意义(P>0.05);UBE组手术时间、住院时间短于MSLD组(P<0.05);UBE组术后3 d、术后1个月腰部VAS评分低于MSLD组(P<0.05);术后3 d UBE组CRP、IL-6、TNF-α、CK水平均低于MSLD组,Hb水平高于MSLD组(P<0.05);UBE组术后1个月ODI指数低于MSLD组(P<0.05),UBE组术后12个月手术节段椎间隙高度高于MSLD组(P<0.05)。结论UBE下髓核摘除术与MSLD治疗老年LDH均能获得良好临床效果,前者创伤更小、术后恢复快、短期可显著减轻患者疼痛、炎症与应激反应,促进腰椎功能恢复、减少椎间隙高度丢失,安全可靠,值得在临床推广实践。Objective To explore the value of unilateral biportal endoscopic(UBE)technique in the treatment of lumbar disc herniation(LDH)in the elderly through comparison with microscopic lumbar discectomy(MSLD).Methods A total of 80 elderly patients with LDH admitted to the hospital from May 2019 to December 2022 were enrolled in this study.They were divided into UBE group(n=40,discectomy under UBE technique)and MSLD group(n=40,MSLD)according to different surgical methods.The perioperative related indicators(operation time and length of hospital stay)were compared between the two groups.Patients enrolled were followed up for 12 months.Clinical efficacy,the Visual Analogue Scale(VAS)scores of lower limb and low back pain,the levels of inflammatory factors[C-reactive protein(CRP),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)],creatine kinase(CK)and hemoglobin(Hb),intervertebral space height of the surgical segment,and Oswestry Disability Index(ODI)were compared between the two groups.Complications in the two groups were recorded.Results There was no statistically significant difference between UBE group and MSLD group in terms of the excellent and good rate of efficacy(92.50%vs 90.00%)and the incidence of complications(2.50%vs 7.50%)(P>0.05).Operation time and hospital stay of UBE group were shorter than those of MSLD group(P<0.05).VAS scores for waist of UBE group were lower than those of MSLD group on day 3 and at 1 month after surgery(P<0.05).On day 3 after surgery,the levels of CRP,IL-6,TNF-αand CK in UBE group were lower than those in MSLD group,and the level of Hb was higher than that in MSLD group(P<0.05).ODI of UBE group was lower than that of MSLD group at 1 month after surgery(P<0.05).Intervertebral space height of the surgical segment in UBE group was greater than that in MSLD group at 12 months after surgery(P<0.05).Conclusion Discectomy under UBE technique and MSLD both can achieve good clinical effects in the treatment of elderly LDH.The former causes less trauma and patients can recover faster after

关 键 词：单侧双通道内镜 显微镜下髓核摘除术 老年 腰椎间盘突出症 炎症因子 椎间隙高度 

分 类 号：R681[医药卫生—骨科学]