单边双通道内镜下椎间盘切除术治疗高度游离型腰椎间盘突出症

Unilateral biportal endoscopic discectomy for high-grade migrated lumbar disc herniation

目的 探讨单边双通道内镜技术(unilateral biportal endoscopy,UBE)治疗高度游离型腰椎间盘突出症(lumbar disc herniation,LDH)的疗效。方法 2020年1月—2021年2月,采用UBE行椎间盘切除术治疗23例高度游离型LDH。男14例,女9例;年龄32~76岁,平均48.7岁。患者均有腰腿痛症状。病程2个月~7年,中位数13个月。病变节段:L3、4 2例,L4、5 15例,L5、S1 6例。记录手术时间、术中失血量、患者开始下地活动时间及术后并发症情况。采用疼痛视觉模拟评分(VAS)、改良Oswestry功能障碍指数(ODI)及改良MacNab标准进行疗效评价。结果 所有手术均顺利完成,均未发生硬膜撕裂、硬膜外血肿及神经血管损伤等并发症。手术时间53~96 min,平均71.0 min;术中失血量32~56 mL,平均39.3 mL。患者均于术后1~2 d拔除引流管并佩戴腰围下地活动。患者均获随访,随访时间3~12个月,平均5.7个月。术后各时间点腰痛及下肢痛VAS评分、改良ODI均较术前下降,差异有统计学意义(P<0.05);上述指标术后各时间点间比较,差异均有统计学意义(P<0.05)。末次随访时,根据改良MacNab标准评价临床疗效,达优17例、良4例、可2例,优良率91.3%。随访期间无椎间盘突出复发。结论 采用UBE行椎间盘切除术具有手术操作灵活、视野清晰、术中探查范围广的优点,可有效减少术后髓核残留风险,是治疗高度游离型LDH的有效方法。

Objective To investigate the effectiveness of the unilateral biportal endoscopy(UBE) technique in the treatment of high-grade migrated lumbar disc herniation(LDH).Methods Between January 2020 and February2021,23 cases of high-grade migrated LDH were treated with discectomy via UBE.There were 14 males and 9 females,with a mean age of 48.7 years(range,32-76 years).All patients had low back and leg pain.The disease duration ranged from 2 months to 7 years(median,13 months).Lesion segments were L3,4 in 2 cases,L4,5 in 15 cases,and L5,S1 in 6 cases.The operation time,intraoperative blood loss,the time when the patients started to move off the floor,and postoperative complications were recorded.The effectiveness was evaluated using the visual analogue scale(VAS) score,the modified Oswestry disability index(ODI),and the modified MacNab criteria.Results All operations were completed successfully,and no complication such as dural tear,epidural hematoma,nerve injury,or vascular injury occurred.The operation time ranged from 53 to 96 minutes,with an average of 71.0 minutes.The intraoperative blood loss ranged from 32 to 56 mL,with an average of 39.3 mL.All patients were removed the drainage tube and wore a lumbar brace to move off the floor around 1 to 2 days after operation.All patients were followed up 3-12 months after operation,with an average of5.7 months.The VAS scores of low back pain and leg pain and the modified ODI at all postoperative time points were lower than those before operation,and the differences were significant(P<0.05).The differences were significant(P<0.05) when comparing the above indexes between the time points after operation.At last follow-up,the effectiveness was evaluated according to the modified MacNab criteria,and 17 cases were excellent,4 cases were good,and 2 cases were fair,with an excellent and good rate of 91.3%.There was no recurrence of LDH during follow-up.Conclusion Discectomy via UBE is an effective method for the treatment of high-grade migrated LDH because of its flexibility,clear view,and wide range of intraoperative exploration,which can effectively reduce the risk of residual nucleus pulposus after operation.