腰椎侧隐窝狭窄伴椎间盘突出症两种内镜术比较

Comparison of two kinds of endoscopic surgery for lumbar lateral recess stenosis accompanied with disc herniation

[目的]比较单侧双通道内镜术(unilateral biportal endoscopy spinal surgery, UBE)与经皮椎板间入路内镜术(percutaneous interlaminar endoscopic discectomy, PIED)治疗腰椎侧隐窝狭窄伴椎间盘突出症的临床疗效。[方法]回顾性分析2018年11月—2020年11月收治的60例单节段腰椎侧隐窝狭窄伴椎间盘突出患者的临床资料,按术前医患沟通结果分为两组,30例行UBE术,30例行PIED术,比较两组围手术期、随访及辅助检查资料。[结果] UBE组手术时间显著少于PIED组(P<0.05),切口总长度大于PIED组(P<0.05)。两组间术中失血量、透视次数、下地行走时间、切口愈合等级、住院时间差异均无统计学意义(P>0.05)。两组术后随访时间平均(21.48±6.82)个月,两组完全负重活动时间的差异无统计学意义(P>0.05)。随时间推移,两组腰痛、腿痛VAS和ODI评分均显著降低(P<0.05),而JOA评分显著增加(P<0.05)。相应时间点,两组间腰痛、腿痛VAS和ODI、JOA评分的差异均无统计学意义(P>0.05)。辅助检查方面,与术前相比,两组术后肌红蛋白浓度、侧隐窝前后径及椎管面积均显著增加(P<0.05),椎间隙高度无显著变化(P>0.05),相应时间点,两组间辅助检查指标的差异均无统计学意义(P>0.05)。[结论] UBE与PIED治疗腰椎侧隐窝狭窄伴椎间盘突出症均微创有效,但UBE手术时间更短。

[Objective] To compare the clinical outcomes of unilateral biportal endoscopy(UBE) versus percutaneous interlaminar endoscopic discectomy(PIED) for lumbar lateral recess stenosis accompanied with disc herniation. [Methods] A total of 60 patients received endoscopic surgeries for single-segment lumbar lateral recess stenosis accompanied by disc herniation in our hospital from November 2018 to November 2020. Based on preoperative doctor-patient communication, 30 patients had UBE performed, while the other 30 patients had PIED conducted. The documents regarding to perioperative period, follow-up and laboratory and imaging examinations were compared between the two groups. [Results] The UBE group consumed significantly shorter operation time, whereas had significantly longer incision than the PIED group(P<0.05), although there were no statistical differences between the two groups in terms of blood loss, fluoroscopy times, time to return walking postoperatively, healing grade of incision and hospital stay(P>0.05). There was no significant difference in the time to resume full-weight bearing activity between the two groups(P>0.05). As time went during follow-up lasted for(21.48±6.82) months on an average, the VAS scores of low back pain and leg pain, as well as ODI scores decreased significantly(P<0.05), whereas the JOA scores increased significantly in both groups(P<0.05). However, there were no statistically significant differences in abovementioned items between the two groups at any matching time points(P>0.05). In terms of auxiliary examinations, the blood myoglobin, anteroposterior diameter of lateral recess and the area of the involved spinal canal increased significantly(P<0.05), while the intervertebral space height remained unchanged postoperatively compared with those preoperatively in both groups(P>0.05), which were not statistically significantly different between the two groups at any corresponding time points(P>0.05). [Conclusion] Both UBE and PIED are effective and minimally invasive techniques for lumbar lateral recess stenosis accompanied with disc herniation, but UBE takes an advantage of shortening operation time.