单侧双通道全内镜辅助椎间植骨融合内固定术治疗复发性腰椎间盘突出症的病例系列研究

Case series of unilateral double-channel endoscope-assisted bone graft fusion and internal fixation in the treatment of recurrent lumbar disc herniation

目的探讨采用单侧双通道全内镜辅助下植骨融合内固定术(ULIF)治疗复发性腰椎间盘突出症患者的临床疗效。方法回顾性分析2020年8月至2020年10月在西安交通大学附属红会医院接受ULIF治疗的22例复发性腰椎间盘突出症患者的临床资料。研究指标包括术中出血量、手术时间、卧床时间、住院时间。收集随访资料包括患者术前、术后1周、6个月时评定的腰腿痛视觉模拟评分(VAS)、日本骨科协会评分(JOA评分)、OSwestry残疾指数(ODI)评分、36项简明健康状况调查(SF-36)评分,以评估患者术后的临床疗效。结果平均手术时间为(179.15±42.06)min,平均术中出血量为(132.67±41.92)mL,平均卧床时间为(1.51±0.42)d,平均住院时间为(4.82±1.13)d。术后1周的腰腿痛VAS评分均较术前降低(均P<0.0001),且在后续随访中进一步降低。术后随访的ODI评分,JOA评分,SF-36评分较术前相比,差异有统计学意义(P<0.05)。术后1周满意率达86.4%,术后6个月满意率为95.4%。术后1周及术后6月时临床疗效显著的比例分别为18.2%和63.6%。结论ULIF手术具有短期恢复快、术中出血量少、卧床时间及住院时间短及中期临床疗效佳等特点,是治疗复发性腰椎间盘突出症可供脊柱外科医师选择的一种安全可靠的微创技术。

Objective To explore the clinical effect of unilateral double-channel endoscope-assisted bone graft fusion and internal fixation(ULIF)in the treatment of recurrent lumbar disc herniation.Methods The clinical data of 22 patients with recurrent lumbar disc herniation treated by ULIF in our hospital from August 2020 to October 2020 were analyzed retrospectively.The study indicators included intraoperative blood loss,operation time,bed rest time,and hospital stay.The follow-up data included visual analogue score(VAS)of low back pain,Japanese Orthopaedic Association score(JOA),OSwestry disability index(ODI)score,as well as 36 concise health status survey(SF-36)scores before operation,and 1 week and 6 months after operation.Results The average operation time was(179.15±42.06)minutes,the average intraoperative blood loss was(132.67±41.92)mL,the average bed rest time was(1.51±0.42)days,and the average hospital stay was(4.82±1.13)days.The VAS score of low back pain at 1 week after operation was lower than that before operation(all P<0.0001),and further decreased during the follow-up.The ODI score,JOA score and SF-36 score of postoperative follow-up were significantly different from those before operation(P<0.05).The satisfaction rate was 86.4%at 1 week after operation and 95.4%at 6 months after operation.The proportion of significant clinical efficacy at 1 week after operation and postoperative 6 months was 18.2%and 63.6%,respectively.Conclusion ULIF has the advantages of short-term recovery,less intraoperative blood loss,short bed rest and hospital stay,and good medium-term clinical effect.It is a safe and reliable minimally invasive technique for spinal surgeons in the treatment of recurrent lumbar disc herniation.