单侧双通道内镜与单通道内镜下髓核摘除治疗腰椎间盘突出症的疗效对比研究

A comparative study of unilateral two-channel endoscopy and single-channel endoscopic nucleus pulposus extraction in the treatment of lumbar disc herniation

目的 探讨单侧双通道内镜(UBE)与单通道内镜下髓核摘除治疗腰椎间盘突出症的临床疗效对比。方法 选择浙江省舟山定海广华医院2019年1月-2021年1月收治的腰椎间盘突出症90例,随机分为单通道内镜组和单侧双通道内镜组,每组45例。单通道内镜组行单通道内镜下腰椎间盘摘除术,单侧双通道内镜组行单侧双通道内镜下髓核摘除术,比较两组治疗前后髓核回缩效应;直腿抬高评分(SLR)及Oswestry功能障碍指数(ODI);比较两组治疗1、4及12周的疼痛情况;比较两组术中出血量及术后术后住院时间以及并发症(硬膜外血肿、硬膜撕裂率)发生情况。结果 治疗后,单侧双通道内镜组SLR评分及O-DI评分优于单通道内镜组(P<0.05);治疗1周、4周及12周后单侧双通道内镜组VAS评分低于单通道内镜组,差异具有统计学意义(P<0.05或P<0.01);治疗后,两组髓核最大前后径及横组内比较差异具有统计学意义(P<0.05),单侧双通道内镜组效果优于单通道内镜组,差异有统计学意义(P<0.05);单侧双通道内镜组较单通道内镜组术中出血量少、术后住院时间短,差异具有统计学意义(P<0.01);两组硬膜外血肿、硬膜撕裂发生率差异均无统计学意义(P>0.05)。结论 UBE治疗腰椎间盘突出具有减少术中出血,缩短住院时间,改善髓核状态,改善肢体功能,提高优良率及缓解远期疼痛的优势。

Objective To compare the clinical efficacy of unilateral dual channel endoscopy(UBE)and single channel endoscopic nucleus pulposus removal in the treatment of lumbar disc herniation.Method 90 patients with lumbar disc herniation who visited Guanghua Hospital in Dinghai,Zhoushan,Zhejiang Province from January 2019 to January 2021 were randomly divided into a single channel endoscopic group and a unilateral dual channel endoscopic group,with 45 patients in each group.The single channel endoscopic group received percutaneous lumbar discectomy under spinal endoscopy,while the unilateral dual channel endoscopic group received unilateral dual channel endoscopic technique for nucleus pulposus removal.The effect of nucleus pulposus retraction before and after treatment was compared between the two groups;Straight Leg Rise Score(SLR)and Oswestry Dysfunction Index(ODI);Compare the pain status of the two groups after 1 week,4 weeks,and 12 weeks of treatment;Compare the intraoperative bleeding volume,postoperative hospital stay,and incidence of complications(epidural hematoma,epidural tear rate)between the two groups.After treatment,the SLR and O-DI scores of the unilateral dual channel endoscopic group were better than those of the single channel endoscopic group(P<0.05);After 1 week,4 weeks,and 12 weeks of treatment,the VAS score of the unilateral dual channel endoscopic group was lower than that of the single channel endoscopic group,and the difference was statistically significant(P<0.05 or P<0.01);After treatment,there was a statistically significant difference in the maximum anteroposterior diameter and transverse diameter of the nucleus pulposus between the two groups(P<0.05),and the effect of the unilateral dual channel endoscopic group was better than that of the single channel endoscopic group,and it was statistically significant(P<0.05);The unilateral dual channel endoscop ic group had less intraoperative bleeding and shorter postoperative hospital stay compared to the single channel endoscopic group,and the difference was statistically significant(P<0.01);There was no statistically significant difference in the incidence of epidural hematoma and tear between the two groups(P>0.05).Conclusion UBE treatment for lumbar disc herniation has the advantages of reducing intraoperative bleeding,shortening hospital stay,improving nucleus pulposus status,improving limb function,increasing excellent and good rates,and alleviating long-term pain.