单边双通道内镜技术与经皮椎间孔镜技术治疗单节段腰椎间盘突出症的临床疗效比较

To compare the clinical efficacy of unilateral biportal endoscopic technique and percutaneous transforaminal endoscopic technique in the treatment of single-segment lumbar disc herniation

目的比较单边双通道内镜(UBE)技术与经皮椎间孔镜技术治疗单节段腰椎间盘突出症的临床疗效。方法以回顾性分析为法,选择2020年10月至2022年10月广州中医药大学第三附属医院收治入院的60例单节段腰椎间盘突出症患者作为观察对象,根据不同术式分为UBE治疗组(n=30)与经皮椎间孔镜治疗组(n=30)。比较两组患者术中出血量、手术时间、住院时间、手术前后腰腿痛视觉模拟评分法(VAS)评分、Oswestry功能障碍指数(ODI)、症状改善优良率、并发症(切口愈合不良、下肢感觉异常、硬膜外血肿)发生率。结果UBE治疗组患者术中出血量为(86.47±29.78)mL,明显高于经皮椎间孔镜治疗组[(62.98±14.61)mL],手术时间、住院时间分别为(60.58±11.52)min、(5.87±1.59)d,明显长于经皮椎间孔镜治疗组[(34.45±9.63)min、(2.98±1.46)d],差异均有统计学意义(P<0.05)。术后,两组患者VAS评分、ODI指数均较术前明显下降,差异均有统计学意义(P<0.05);UBE治疗组术后ODI指数为(11.93±2.64)%,明显高于经皮椎间孔镜治疗组[(10.51±2.38)%],差异有统计学意义(P<0.05);两组患者术后VAS评分、症状改善优良率与切口愈合不良、下肢感觉异常、硬膜外血肿发生率比较,差异均无统计学意义(P>0.05)。结论UBE技术与经皮椎间孔镜技术治疗单节段腰椎间盘突出症的临床疗效均显著,具有创伤小、并发症少及术后恢复迅速等优势,但UBE技术的手术效率相对更高,减压效果相对更优,操作更为灵活简便,而经皮椎间孔镜技术的创伤相对更小,术后恢复更为迅速。

Objective To compare the clinical efficacy of unilateral double-channel endoscopy(UBE)and percutaneous intervertebral foramen endoscopy in the treatment of single-segment lumbar disc herniation.Methods With the method of retrospective analysis,60 patients with single-segment lumbar disc herniation admitted to The Third Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from October 2020 to October 2022 were observed.They were divided into UBE treatment group(n=30)and percutaneous intervertebral foramen treatment group(n=30)according to different surgical procedures.The intraoperative blood loss,operation time,hospital stay,Oswestry dysfunction index(ODI),visual analogue scale(VAS)score of lumbago and leg pain before and after operation,excellent and good rate of symptom improvement and incidence of complications(poor wound healing,lower limb paresthesia,epidural hematoma)were compared between the two groups.Results The intraoperative blood loss in the UBE treatment group was(86.47±29.78)mL,which was significantly higher than that in the percutaneous foramen treatment group[(62.98±14.61)mL],the operation time and hospital stay were(60.58±11.52)min and(5.87±1.59)d,which were significantly longer than those in the percutaneous foramen treatment group[(34.45±9.63)min and(2.98±1.46)d],the differences were statistically significant(P<0.05).After operation,the VAS scores and ODI index of the two groups were significantly lower than those before operation,the differences were statistically significant(P<0.05),and the ODI index of UBE treatment group was(11.93±2.64)%,which was significantly higher than that in the percutaneous endoscopic treatment group[(10.51±2.38)%],the difference was statistically significant(P<0.05);there was no statistically significant difference between the two groups in VAS score,excellent and good rate of symptom improvement and the incidence of poor wound healing,lower limb paresthesia and epidural hematoma(P>0.05).Conclusion UBE and percutaneous transforaminal endoscopic discectomy are both effective in the treatment of single-level lumbar disc herniation,with the advantages of less trauma,fewer complications and rapid postoperative recovery.But UBE has higher efficiency,better decompression effect and more flexible and simple operation,while percutaneous transforaminal endoscopic discectomy has less trauma and faster postoperative recovery.