经皮内镜腰椎间盘切除术和单侧双通道内镜腰椎间盘切除术治疗143例腰椎间盘突出症患者的临床疗效分析

Clinical effect analysis of percutaneous endoscopic lumbar discectomy and unlateral biportal endoscopic lumbar discectomy in 143 patients with lumbar disc herniation

目的通过临床回顾性研究比较经皮内镜腰椎间盘切除术(percutaneous endoscopic lumbar discectomy,PELD)和单侧双通道内镜技术(unlateral biportal endoscopic technique,UBE)腰椎间盘切除术治疗腰椎间盘突出症(lumbar disc herniation,LDH)的临床疗效。方法回顾性分析2020年1月至2022年4月期间因LDH入武汉科技大学附属天佑医院脊柱外科行PELD或UBE手术治疗者143例,并分为两组,其中PELD组患者80例,UBE组患者63例。收集患者的手术时间、住院总时间、平均切口长度、术中透视次数,术前,术后12、24、48 h的疼痛视觉模拟评分(visual analogue scale,VAS)等围手术期资料,同时收集患者术后院外近1年随访周期内有无切口红肿渗液或感染、硬膜外血肿、髓核组织影像学残留、神经损伤、周围组织损伤等并发症及LDH复发情况,并统计患者在末次随访时的Oswestry功能障碍评分(Oswestry disability index,ODI)和改良的MacNab疗效评分。结果两组患者院外随访9~12个月,平均随访(11.08±0.91)个月。两组患者在手术时间、住院总时间,术后12、24、48 h的VAS评分方面比较,差异无统计学意义(P>0.05);在平均切口长度方面,UBE组患者明显高于PELD组患者(P<0.05);但在术中透视次数方面,UBE组患者少于PELD组患者(P<0.05)。在术后并发症方面,截至出院后末次随访时,两组患者比较差异无统计学意义(P>0.05)。而在术后LDH复发情况中,PELD组患者明显高于UBE组患者(P<0.05)。在末次随访的ODI评分和改良的MacNab疗效评分中,PELD组和UBE组患者整体评分差异无统计学意义(P>0.05)。结论PELD和UBE治疗LDH均能取得较为满意的临床疗效,虽然UBE技术带来的医源性损伤相对较大,但考虑到术中较少的透视次数、远期较低的LDH复发率,临床医生对LDH患者的手术治疗可以选择性地考虑应用UBE技术开展腰椎椎间盘切除。

Objective To compare the clinical efficacy of percutaneous endoscopic lumbar discectomy(PELD)and unlateral biportal endoscopic technique(UBE)in the surgery of lumbar disc herniation(LDH).Methods From January 2020 to April 2022,143 patients admitted to the spinal surgery department of Tianyou Hospital,Wuhan University of Science and Technology for LDH who underwent PELD or UBE surgery were retrospectively analyzed and divided into two groups,including 80 patients in the PELD group and 63 patients in the UBE group.Perioperative data such as operation time,total hospital stay,average incision length,intraoperative fluoroscopy times and visual analogue scale(VAS)scores before surgery,12 h,24 h and 48 h after surgery were collected.At the same time,the complications(such as incision redness,swelling,effusion or infection,epidural hematoma,imaging residual nucleus pulposus tissue,nerve injury and peripheral tissue injury)and the recurrence of LDH were collected during the nearly 1-year-follow-up period.The Oswestry disability index(ODI)and modified MacNab efficacy score of patients at the last follow-up were analyzed.Results Patients in the two groups were followed up for 9-12 months,with an average follow-up time of(11.08±0.91)months.There was no significant difference between PELD group and UBE group in operation time,total hospital stay,VAS score at 12 h,24 h and 48 h after surgery(P>0.05).In terms of mean incision length,patients in the UBE group were significantly higher than those in the PELD group(P<0.05),but the number of intraoperative fluoroscopy in the UBE group was less than that in the PELD group(P<0.05).In terms of postoperative complications,there was no significant difference between the two groups(P>0.05).However,the recurrence of postoperative LDH in the PELD group was significantly higher than that in the UBE group(P<0.05).In the ODI score and the modified MacNab efficacy score at the last follow-up,there was no significant difference in the overall score between the PELD group and the UBE group(P>0.05).Conclusion Both PELD and UBE can achieve satisfactory clinical efficacy in the treatment of LDH.Although the iatrogenic injury caused by UBE is relatively large,considering the fewer intraoperative fluoroscopy times and the lower long-term recurrence probability of LDH,the clinician may selectively consider the use of UBE technique for lumbar discectomy in the surgical treatment of LDH patients.