单侧双通道内镜技术和椎间孔镜技术治疗腰椎退行性疾病的疗效对比研究

A comparative study of unilateral biportal endoscopy technique and percutaneous transforaminal endoscopic discectomy technique in the treatment of lumbar degenerative diseases

目的比较单侧双通道内镜技术和椎间孔镜技术治疗腰椎退行性疾病的疗效,为临床治疗提供参考。方法选择邯郸市中心医院2020年2月至2021年6月收治的84例腰椎退行性疾病患者开展前瞻性研究,根据手术方式不同分为观察组(单侧双通道内镜治疗)与对照组(椎间孔镜治疗),每组各42例。观察组给予单侧双通道内镜治疗,对照组给予椎间孔镜治疗。记录比较两组围手术期指标,通过改良MacNab评定标准比较两组术后1.5年疗效,比较两组术前、术后1个月、2个月及1.5年腰部及下肢视觉疼痛模拟评分(VAS),比较两组术前、术后1个月、2个月及1.5年Oswestry功能障碍指数(ODI),观察比较两组并发症发生情况。结果观察组术中出血量、住院时间分别为(54.61±12.39)mL、(7.96±1.77)d,显著少于对照组[(132.57±18.24)mL、(9.72±1.73)d],差异均有统计学意义(P<0.05);两组手术时长组间比较,差异无统计学意义(P>0.05);术后1个月,观察组硬膜囊面积(133.59±16.84)mm^(2),显著大于对照组[(116.37±16.29)mm^(2)],差异有统计学意义(P<0.05)。观察组与对照组疗效比较,差异无统计学意义(P>0.05)。两组术后1个月、2个月、1.5年腰部及下肢VAS评分显著低于术前,且观察组术后1个月、2个月腰部VAS评分分别为(3.18±0.86)、(2.39±0.61)分,显著低于对照组[(4.17±1.15)、(1.79±0.45)分],差异均有统计学意义(P<0.05),观察组术后1个月、2个月下肢VAS评分、术后1.5年腰部及下肢VAS评分与对照组比较,差异均无统计学意义(P>0.05)。术后1个月、2个月、1.5年,两组ODI水平较术前均有明显下降,差异均有统计学意义(P<0.05);术前、术后2个月、1.5年两组ODI水平组间比较,差异均无统计学意义(P>0.05);观察组术后1个月ODI水平为(31.57±4.25)%,显著低于对照组[(36.86±4.68)%],差异有统计学意义(P<0.05)。两组并发症总发生率比较,差异无统计学意义(P>0.05)。结论单侧双通道内镜技术和椎间孔镜技术治疗腰椎退行性疾病的疗效相当,但单侧双通道内镜技术能够减少术中出血量、住院时间,减轻患者术后前期疼痛,且安全性较高。

Objective To compare the efficacy of unilateral biportal endoscopy technique and percutaneous transforaminal endoscopic discectomy technique in the treatment of lumbar degenerative diseases,so as to provide reference for clinical treatment.Methods A total of 84 patients with lumbar degenerative diseases admitted to Handan City Central Hospital from February 2020 to June 2021 were selected to conduct a prospective study.According to the different surgical methods,they were divided into observation group(unilateral double-channel endoscopic therapy)and control group(foraminal endoscopic therapy),with 42 cases in each group.The observation group was treated with unilateral biportal endoscopy treatment,while the control group was treated with percutaneous transforaminal endoscopic discectomy treatment.Recorded and compared the perioperative indexes of the two groups,compared the efficacy of the two groups after 1.5 years by modified MacNab evaluation standard,compared the visual analogue scale(VAS)of the waist and lower limbs between the two groups before operation,1 month,2 months and 1.5 years after operation,compared the Oswestry disability index(ODI)between the two groups before operation,1 month,2 months and 1.5 years after operation,and observed and compared the incidence of complications between the two groups.Results The intraoperative blood loss and hospital stay in the observation group were(54.61±12.39)mL and(7.96±1.77)d,which were significantly lower than those in the control group[(132.57±18.24)mL and(9.72±1.73)d],and the differences were statistically significant(P<0.05),and there was no statistically significant difference in the operation time between the two groups(P>0.05).One month after operation,the area of dural sac in the observation group was(133.59±16.84)mm^(2),which was significantly larger than that in the control group[(116.37±16.29)mm^(2)],and the difference was statistically significant(P<0.05).The VAS scores of waist and lower limbs at 1 month,2 months and 1.5 years after operation were significantly lower than those before operation,and the VAS scores of waist in the observation group at 1 month and 2 months after operation were(3.18±0.86),(2.39±0.61)points,which were significantly lower than those in the control group[(4.17±1.15),(1.79±0.45)points],and the differences were statistically significant(P<0.05).There was no statistically significant difference in VAS scores of lower extremities at 1 month and 2 months after operation,and VAS scores of lower extremities at 1.5 years after operation between the observation group and the control group(P>0.05).The ODI level of the observation group was significantly lower than that of the control group at 1 month,2 months and 1.5 years after operation,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the ODI level between the two groups before operation,2 months and 1.5 years after operation(P>0.05).The ODI level in the observation group one month after the operation was(31.57±4.25)%,which was significantly lower than that in the control group(36.86±4.68)%),and the difference was statistically significant(P<0.05).There was no statistically significant difference in the total incidence of complications between the two groups(P>0.05).Conclusion The efficacy of unilateral biportal endoscopy technique and percutaneous transforaminal endoscopic discectomy technique in the treatment of lumbar degenerative diseases is comparable.However,unilateral biportal endoscopy technique can reduce intraoperative blood loss,length of hospital stay,reduce the pain of patients in the early postoperative period,and has high safety.