单侧双通道内镜技术下髓核摘除术与Delta通道下经椎板间入路髓核摘除术治疗腰椎间盘突出症的近远期疗效及安全性分析

Short-term and long-term curative effect and safety of unilateral biportal endoscopic discectomy vs.translaminar discectomy under delta channel in the treatment of lumbar disc herniation

目的探究单侧双通道内镜(UBE)技术下髓核摘除术与Delta通道下经椎板间入路髓核摘除术治疗腰椎间盘突出症(LDH)的近远期疗效及安全性。方法 94例入院治疗的L5/S1 LDH患者, 其中46例患者行UBE技术下髓核摘除术(UBE组), 48例行Delta通道下经椎板间入路髓核摘除术(Delta组)。比较两组疗效、腰腿部疼痛情况、腰椎功能及围术期指标。组间比较采用t检验、χ^(2)检验或Fisher精确概率, 重复测量数据采用重复测量资料方差分析。结果两组患者术后各时间点腰腿部VAS评分均低于术前(P<0.05), 术后3 d时, UBE组腰部VAS评分高于Delta组[(1.55±0.33)分比(1.29±0.28)分, t=4.125, P<0.05];两组患者术后各时间点ODI评分均低于术前(P<0.05), 但两组术后各时间点ODI评分比较, 差异无统计学意义(P>0.05);UBE组椎管外操作时间、术中出血量和切口长度高于Delta组[(30.58±5.49) min比(17.63±4.86) min、(54.29±7.72) ml比(18.32±4.41) ml、(14.37±1.12) mm比(9.75±0.95) mm, t=12.122、27.884、21.600, P<0.05], UBE组椎管内操作时间低于Delta组[(35.62±9.72) min比(43.73±10.45) min, t=3.892, P<0.05], 但两组总手术时间、术后住院时间和手术相关并发症发生率比较, 差异无统计学意义(6.52%比8.33%, P>0.05);术后12个月, 两组治疗优良率比较, 差异无统计学意义(91.30%比87.50%, P>0.05)。结论 UBE技术下髓核摘除术与Delta通道下经椎板间入路髓核摘除术治疗LDH疗效相近, UBE技术椎管内操作效率更高, 而Delta技术手术创伤更小。

Objective To explore the short-term and long-term curative effect and safety of unilat-eral biportal endoscopic(UBE)discectomy vs.translaminar discectomy under Delta channel in the treat-ment of lumbar disc herniation(LDH).Methods A total of 94 patients with L5/S1 LDH treated in our hospital were enrolled,including 46 cases in UBE group(UBE discectomy)and 48 cases in Delta group(translaminar discectomy under Delta channel).The curative effect,waist and leg pain,lumbar function and perioperative indexes were compared between the two groups.Results After surgery,VAS scores of waist and leg in both groups were decreased(P<0.05).At 3rd d after surgery,VAS score of waist in UBE group was higher than that in Delta group[(1.55±0.33)points vs.(1.29±0.28)points,t=4.125,P<0.05].After surgery,ODI scores in both groups were decreased(P<0.05),but there was no significant difference between the two groups(P>0.05).The extraspinal operation time,intraoperative blood loss and incision length in UBE group were(30.58±5.49)min,(54.29±7.72)ml and(14.37±1.12)mm,significantly different from those in Delta group[(17.63±4.86)min,(18.32±4.41)ml,(9.75±0.95)mm,t=12.122,27.884,21.600,P<0.05].The intraspinal operation time in UBE group was shorter than that in Delta group[(35.62±9.72)vs.(43.73±10.45)min,t=3.892,P<0.05],but there was no significant difference in total operation time,postoperative hospitalization time or incidence of surgery-related complications between the two groups(6.52%vs.8.33%,P>0.05).At 12th month after surgery,there was no significant difference in good rate of treatment between the two groups(91.30%vs.87.50%,P>0.05).Conclusion UBE discectomy is similar to translaminar discectomy under Delta channel in the treatment of LDH.UBE has higher extraspinal operation efficiency,while Delta has less surgical trauma.