两种术式治疗脱出游离型腰椎间盘突出症伴腰椎不稳的比较

Comparison of Two Surgical Approaches in the Treatment of Prolapsed Lumbar Disc Herniation with Lumbar Instability

目的对比单边双通道内镜技术(unilateral biportal endoscopy,UBE)与微创经椎间孔入路腰椎椎间融合术(minimally invasive surgery-transforaminal lumbar interbody fusion,MIS-TLIF)治疗脱出游离型腰椎间盘突出症伴腰椎不稳的短期疗效。方法回顾性研究2019年7月至2021年9月苏北人民医院骨科收治的脱出游离型腰椎间盘突出症伴腰椎不稳的46例患者资料。根据手术方式不同分为UBE组和MIS-TLIF组,其中UBE组患者22例,男10例,女12例;年龄37~71岁,平均(67.6±9.2)岁。MIS-TLIF组患者24例,男11例,女13例;年龄52~75岁,平均(66.7±8.6)岁。比较两组患者手术时间、切口长度、术后引流量、住院天数、疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)、改良MacNab标准评分、融合率及并发症情况。结果与MIS-TLIF组相比,UBE组手术时间较长,术后引流量较少,住院时间较短,手术切口较小,差异有统计学意义。手术疗效方面,UBE患者在术后随访2周、1个月、3个月的VAS评分均低于MIS-TLIF组,差异有统计学意义,且术后3个月差异显著,术后6个月和12个月随访时两组差异无统计学意义。两组术后2周、1个月ODI评分比较差异有统计学意义,且UBE组评分较低,而术后3、6、12个月时两组差异无统计学意义。术后6个月时,两组患者优良率及融合率比较,差异无统计学意义。结论单边双通道技术治疗脱出游离型腰椎间盘突出症伴腰椎不稳,可以使手术切口更小,能术后早期缓解患者疼痛,并且其操作灵活、视野开阔,临床上值得推广。

Objective To compare the short-term efficacy of unilateral biportal endoscopy(UBE)and minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)in the treatment of prolapsed lumbar disc herniation with lumbar instability.Methods A study of 46 patients with prolapsed lumbar intervertebral disc herniation and lumbar instability who were admitted to the department of orthopedics spine of Northern Jiangsu People's Hospital from July 2019 to September 2021 was retrospectively analyzed.According to the surgical methods,they were divided into UBE group and MIS-TLIF group.There were 22 patients in UBE group,including 10 males and 12 females.The patients aged 37~71 years,with an average age of(67.6±9.2)years.There were 24 patients in MIS-TLIF group,including 11 males and 13 females.The patients aged 52 to 75 years,with an average age of(66.7±8.6)years.The operation time,incision length,postoperative drainage volume,length of hospital stay,visual analogue scale(VAS),oswestry disability index(ODI),modified MacNab criteria,fusion rate and complications were compared between the two groups.Results Compared to the MIS-TLIF group,the operation time of the UBE group was longer,but the postoperative drainage volume was less than that of the MIS-TLIF group,the hospital stay was shorter,and the surgical incision was smaller.The difference was statistically significant.In terms of surgical efficacy,the VAS scores of UBE patients at the 2-week,1-month,and 3-month follow-up were lower than those of the MIS-TLIF group,and the differences between the two groups were statistically significant,especially at 3 months after surgery.Also,there were no statistically significant differences between the two groups at the 6-month and 12-month follow-up.There were statistically significant differences between the two groups in ODI score at the 2-week and 1-month follow-up and patients in the UBE group presented with lower scores.There were no statistically significant differences between the two groups at the 3-month,6-month and 12-month follow-up.At the 6-month follow-up after surgery,there were no statistically significant differences between the two groups in terms of the excellent and good rate and the fusion rate.Conclusion Unilateral biportal endoscopy for the treatment of prolapsed lumbar disc herniation with lumbar instability allows for smaller surgical incisions,relief of patient pain in the early postoperative period,and its operational flexibility and open field of view are worth promoting clinically.