腰椎间盘突出症两种微创手术临床比较

Comparison of two minimally invasive surgeries for lumbar intervertebral disc herniation

[目的]比较单侧双通道内镜下椎间盘切除(unilateral biportal endoscopic,UBE)与微创通道下椎间盘切除(minimally invasive tubular discectomy,MITD)治疗单节段腰椎间盘突出症的临床疗效。[方法]回顾性分析2020年8月—2021年8月166例于本院行单节段微创腰椎间盘突切除术患者的临床资料。依据术前医患沟通结果,50例采用UBE,116例采用MITD。比较两组围手术期、随访和影像资料。[结果]UBE组手术时间显著长于MITD组[(107.9±19.0)min vs(63.2±11.0)min,P<0.05],但是,UBE组切口长度[(2.0±0.2)cm vs(2.8±0.3)cm,P<0.05]、术中透视次数[(2.7±0.8)次vs(3.2±1.1)次,P<0.05]、术中失血量[(30.8±15.6)ml vs(42.0±22.3)ml,P<0.05]、住院时间[(8.7±2.1)d vs(10.2±3.9)d,P<0.05]均显著少于MITD组。两组下地时间、切口愈合等级的差异无统计学意义(P>0.05)。所有患者随访时间平均(15.7±3.5)个月,两组完全负重活动时间的差异无统计学意义(P>0.05)。随时间推移,两组患者腰痛VAS评分、腿痛VAS评分和ODI评分均显著减少(P<0.05);相应时间点,两组间VAS和ODI评分差异均无统计学意义(P>0.05)。影像方面,与术前相比,术后1、6个月、末次随访时,两组椎间隙高度、椎管占位面积百分比均显著减少(P<0.05);但相应时间点两组间上述影像指标的差异无统计学意义(P>0.05)。[结论]应用UBE治疗单节段腰椎间盘症可以取得与MITD相似的临床疗效,但UBE创伤更小,术中透视次数更少,住院时间进一步缩短。

[Objective]To compare clinical efficacy of unilateral biportal endoscopic discectomy(UBE)versus minimally invasive tubu⁃lar discectomy(MITD)for single-segment intervertebral disc herniation.[Methods]A retrospective study was done on 166 patients who un⁃derwent minimally invasive lumbar discectomy for single-level disc protrusion in our hospital from August 2020 to August 2021.According to preoperative doctor-patient communication,50 patients were treated with UBE,while the remaining 116 patients received MITD.Periop⁃erative,follow-up and imaging data were compared between the two groups.[Results]Although the UBE consumed significantly longer oper⁃ation time than the MITD group[(107.9±19.0)min vs(63.2±11.0)min,P<0.05],the former proved significantly less than the latter in terms of incision length[(2.0±0.2)cm vs(2.8±0.3)cm,P<0.05],intraoperative fluoroscopy times[(2.7±0.8)vs(3.2±1.1)times,P<0.05],intraopera⁃tive blood loss[(30.8±15.6)ml vs(42.0±22.3)ml,P<0.05],and hospital stay[(8.7±2.1)days vs(10.2±3.9)days,P<0.05].There was no signif⁃icant difference in postoperative ambulation time and incision healing grade between the two groups(P>0.05).All the patients in both groups were followed up for(15.7±3.5)months on a mean,and there was no significant difference in the time to resume full weight-bearing activities between the two groups(P>0.05).The VAS scores both for lower back pain and leg pain,as well as ODI score decreased significantly in both groups with time(P<0.05),which was not statistically significant between the two groups at any time points accordingly(P>0.05).With re⁃gard to imaging,the height of intervertebral space and the percentage of vertebral canal occupying area significantly reduced in both groups at 1 month,6 months and the last follow-up after surgery compared with those preoperatively(P<0.05),whereas which proved not significant⁃ly different between the two groups at the corresponding time points(P>0.05).[Conclusion]The UBE used in the treatment of single-level lumbar disc disease does achieve similar clinical efficacy as MITD.By contrast,the UBE has less trauma,fewer intraoperative fluoroscopy,and further shortened hospital stay.