单、双通道内镜技术治疗脱出游离型腰椎间盘突出症的近期疗效比较

Comparison of short-term effects of single and dual channel endoscopic techniques in the treatment of prolapsed free lumbar disc herniation

目的:比较经皮侧路椎间孔镜(PELD)与单侧双通道内镜(UBE)治疗脱出游离型腰椎间盘突出症的临床疗效。方法:回顾性分析2020年1月~2021年1月手术治疗的脱出游离型腰椎间盘突出症47例,PELD组16例,UBE组31例。对比两种内镜技术的手术时长、术中失血量、透视次数等指标。用疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、Macnab标准进行手术疗效评估。结果:PELD组术中透视次数较UBE组更多(P<0.05),但手术时间少于UBE组(P<0.05);两组的术中失血量和住院时间的差异无统计学意义(P>0.05)。随访12~15个月,末次随访时,PELD组腰腿痛恢复水平与UBE组相近,两组间VAS评分与ODI指数差异无统计学意义(P>0.05)。UBE组末次随访时Macnab疗效优良率比PELD组高,差异有统计学意义(P<0.05)。结论:PELD与UBE均明显缓解脱出游离型腰椎间盘突出症患者的症状,但UBE可以更彻底地摘除脱出游离的髓核,其优良率比PELD高,但其手术时间多于PELD组。

Objective:To compare short-term effects of percutaneous endoscopic lumbar discectomy(PELD)and unilateral biportal endoscopy(UBE)in the treatment of prolapsed free lumbar disc herniation(LDH).Methods:The number of 47 patients with prolapsed free LDH who received endoscopic surgery in the First Affiliated Hospital of Jinan University from January 2020 to January 2021 were retrospectively analyzed and 16 patients were treated with PELD and 31 patients were treated with UBE.Variables including the operative time,intraoperative blood loss,and numbers of fluoroscopy of the two groups were compared.The efficacy of each operation was evaluated by Visual Analogue Scale(VAS),modified Oswestry Disability Index(ODI)and the modified Macnab standard.Results:The intraoperative blood loss had no significant difference between the two groups(P>0.05).However,the duration of operation in UBE group were significantly higher than the PELD group(P<0.05).In addition,the intraoperative fluoroscopy frequency in PELD group were also higher than those in the UBE group.The recovery of lumbar-leg pain and ODI dysfunction index at the last time follow-up had no difference(P>0.05).Macnab score evaluation of UBE group was better than the PELD group(P<0.05).Conclusion:Both UBE and PELD for prolapsed free LDH can relieve symptoms significantly.With longer operative time,UBE can more completely remove the free nucleus pulposus and had better evaluation performance.