比较经皮后路单通道与双通道治疗L_(5)~S_(1)腰椎间盘突出症的疗效

A comparison of clinical efficacy of percutaneous endoscopic interlaminar discectomy and unilateral biportal endoscopic discectomy in treatment of L-S lumber disc herniation

目的比较经皮内镜椎板间入路椎间盘切除术(PEID)与单侧双通道内镜下椎间盘切除术(UBED)治疗L_(5)~S_(1)腰椎间盘突出症(LDH)的临床疗效。方法L_(5)~S_(1)LDH患者33例分别采用UBED(UBED组,15例)和PEID(PEID组,18例)治疗。比较两组患者手术相关指标及手术前后VAS疼痛评分、Oswestry功能障碍指数(ODI)评分、血清肌酸激酶(CK)和Hb水平的变化。结果UBED组手术时间和灌洗液使用量多于PEID组(P<0.01)。与术前相比,两组术后腰部和下肢VAS疼痛评分和ODI评分下降,CK水平上升,UBED组Hb水平下降(P<0.01)。术后UBED组Hb水平的下降程度[21(14,25)g/L vs.11(7,18)g/L]、CK水平的上升程度[213(123,234)U/L vs.87(64,113)U/L]较PEID组更明显(P<0.01),PEID组腰部VAS疼痛评分的下降程度较UBED组更明显[3(2,3)分vs.2(1,2)分](P<0.05)。随访6~18个月,UBED组1例发生髓核残留但无神经症状;PEID组1例髓核部分残留且有神经症状,1例出现下肢刺痛等神经根刺激症状。结论UBED和PEID均能有效治疗L_(5)~S_(1)LDH。UBED手术适应证广,操作方便,术野大而清晰;PEID创伤小,出血少,术后腰部疼痛不明显。

Objective To compare the clinical efficacy of percutaneous endoscopic interlaminar discectomy(PEID)and unilateral biportal endoscopic discectomy(UBED)in the treatment of L_(5)~S_(1) lumber disc herniation(LDH).Methods Thirty-three cases with L_(5)~S_(1) LDH were treated by UBED(group A,15 cases)or PEID(group B,18 cases).The operation-related indexes and the changes of VAS pain score,Oswestry disability index(ODI)score,serum creatine kinase(CK)level and hemoglobin level before and after operation were compared.Results The operation time was longer and volume of lavage fluid was more in group A than those in group B(P<0.01).Compare with before operation,the VAS pain scores of lumber and lower limbs and ODI score were decreased while serum CK level was increased in both groups,and hemoglobin level was decreased in group A after operation(P<0.01).After operation,the decrease of Hb level[21(14,25)g/L vs.11(7,18)g/L]and the increase of CK level[213(123,234)U/L vs.87(64,113)U/L]in group A were more obvious than those in group B(P<0.01),and the decrease of lumbar VAS pain score in group B was more obvious than those in group A[3(2,3)points vs.2(1,2)points](P<0.05).All the patients were followed up for 6 to 18 months.One case in group A had residual nucleus pulposus without neurological symptoms.One case had residual nucleus pulposus with neurological symptoms and one case had nerve root irritation symptoms such as lower limb tingling in group B.Conclusion Both UBED and PEID can effectively treat L_(5)~S_(1) LDH.UBED has the advantages of wide indications,convenient operation and large and clear operation field,while PEID has the advantages of less trauma,less bleeding and no obvious postoperative lumbar pain.