单侧双通道脊柱内镜下髓核摘除术联合纤维环缝合术治疗腰椎间盘突出症早期临床疗效

Early effectiveness of unilateral biportal endoscopic discectomy combined with annulus fibrosus suture in the treatment of lumbar disc herniation

目的分析单侧双通道脊柱内镜下髓核摘除术(unilateral biportal endoscopic discectomy,UBED)联合纤维环缝合术治疗腰椎间盘突出症(lumbar disc herniation,LDH)的早期临床疗效。方法回顾分析2020年10月—2021年10月采用UBED联合纤维环缝合术治疗的19例LDH患者临床资料。其中男12例,女7例;年龄26~59岁,平均39.1岁。病变节段:L、13例,L、S6例。病程3~15个月,平均6.7个月。术前神经功能检查示患者肌力、感觉、腱反射均不同程度减弱或消失。根据纤维环裂口位置选择单纯缝合器缝合法(14例)或锚钉辅助缝合法(5例)。术前,术后3 d及3、6个月采用疼痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)评价患者腰腿痛情况和腰椎功能状态;术后3 d及3个月复查腰椎MRI了解髓核摘除及神经减压情况;术后6个月采用MacNab标准评价疗效,并记录神经功能恢复情况。结果19例患者手术均顺利完成,手术时间40~75 min,平均52.7 min。术中无神经损伤、类脊髓高压综合征、硬膜囊撕裂等并发症发生,术后无感染、神经损害加重、脑脊液漏等并发症发生。患者均获随访,随访时间6~10个月,平均8.2个月。术后腰椎MRI复查示突出的髓核组织摘除彻底,神经减压充分髓核无残留;随访期间未见椎间盘突出复发。术后各时间点腰痛、腿痛VAS评分及ODI均较术前显著改善,术后6个月较术后3 d和3个月进一步改善,差异均有统计学意义(P<0.05)。术后6个月采用MacNab标准评价疗效,获优14例、良4例、可1例,优良率94.7%。神经功能检查示,受累神经根支配区的感觉和肌力较术前明显恢复,差异有统计学意义(P<0.05);腱反射恢复不明显,与术前比较差异无统计学意义(P>0.05)。结论UBED联合纤维环缝合术治疗LDH安全、有效,早期临床疗效良好。

Objective To analyze the early effectiveness of unilateral biportal endoscopic discectomy(UBED combined with annulus fibrosus suture in the treatment of lumbar disc herniation(LDH).Methods The clinical data of19 patients with LDH treated with UBED and annulus fibrosus suture between October 2020 and October 2021 were retrospectively analyzed.There were 12 males and 7 females with an average age of 39.1 years(range,26-59 years).The operative segment was Lin 13 cases,and L、Sin 6 cases.The mean disease duration was 6.7 months(range,3-15months).Preoperative neurological examination showed that muscle strength,sensation,and tendon reflex weakened or disappeared in varying degrees.Single annulus fibrosus suture(14 cases)or anchor assisted annulus fibrosus suture(5 cases)was selected according to the location of annulus fibrosus tears.Visual analogue scale(VAS)score was used to assess the low back and leg pain before operation and at 3 days,3 months,and 6 months after operation.Oswestry disability index(ODI)was used to evaluate the function recovery of lumbar spine before operation and at 3 days,3 months,and 6 months after operation.At 3 days and 3 months after operation,MRI was used to examine the removal of nucleus pulposus and decompression of nerve root.MacNab criteria was used to evaluate the effectiveness at 6 months after operation and the recovery of nerve root function was recorded.Results All operations were successfully completed with a mean operation time of 52.7 minutes(range,40-75 minutes).There was no complication such as nerve injury,spinal cord hypertension syndrome,or dural sac tear during operation,and no complication such as infection,aggravation of nerve damage,or cerebrospinal fluid leakage after operation.All the patients were followed up 6-10 months(mean,8.2 months).Postoperative MRI showed that the herniated disc was completely removed and nerve roots were fully decompressed.During the follow-up,there was no recurrence of disc herniation.The VAS scores of low back pain and leg pain and ODI at each time point after operation significantly improved when compared with those before operation,and those at 6 months after operation further improved than those at 3 days and 3 months after operation,all showing significant differences(P<0.05).At 6 months after operation,MacNab standard was used to evaluate the effectiveness,and the results were excellent in 14 cases,good in 4 cases,and fair in 1 case,with an excellent and good rate of 94.7%.Neurological examination showed that the sensation and muscle strength of the affected nerve root innervated area recovered significantly when compared with those before operation(P<0.05);the recovery of tendon reflex was not obvious,showing no significant difference when compared with that before operation(P>0.05).Conclusion UBED combined with annulus fibrosus suture is a safe and effective technique for LDH and early effectiveness is satisfactory.